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Ossiculoplasty: Need, symptoms, treatment and implications

About ossiculoplasty

Ossiculoplasty is a surgical process wherein there is reconstruction of the ossicular chain in the ear. Ossicular chain in a normal person, is formed by three tiny bones called malleus, incus and stapes placed in the middle ear. The malleus is attached to the ear drum on one end and to the incus, at the other end. The incus connects the other two bones. The stapes connects the incus to the oval window of the inner ear. The function of these three ear ossicles is to transmit sound waves from the ear drum to the fluid in the inner ear. When these small bones get damaged, then hearing is drastically affected and leads to conductive hearing loss. Hence their repair or reconstruction is most important for restoring normal hearing.

Ossiculoplasty: Incidence, age and sex

The incidence of ossiculoplasty depends upon the incidence of conductive hearing loss. Conductive hearing loss due to damaged ossicles is very common in the general population. It is encountered more commonly in women than in men. In 80% of the cases, conductive hearing loss is seen due to an infection in the middle ear. It may affect an individual at any age, but is rare in children.

Signs and symptoms that necessitate ossiculoplasty: Diagnosis

Hearing loss due to damage to the ossicles is the main indication for the procedure of ‘ossiculoplasty’. There is usually damage to the joint between the incus and the stapes which needs to be corrected. There may be damage to the malleus bone due to infection. There may be sclerosis in any of the bone, thereby causing deafness. Any person who has conductive hearing loss may undergo ossiculoplasty. There is no major contraindication for this surgery.

The diagnosis of ossicular damage is established by an otolaryngologist, based upon history and physical examination. Audiometric tests may reveal the kind of hearing loss. Radiological investigations like CT or MRI scan may be advised for confirming the presence of ossicular damage.

Causes and the need for ossiculoplasty

Any damage to the ossicles may lead to conductive hearing impairment, which in turn needs to be corrected by ossiculoplasty. Common causes of damage to the ear ossicles include middle-ear infection, sclerosis of bones, or aging. It is important to treat any middle ear infections as soon as possible to prevent damage to the ear ossicles.

Ossiculoplasty: Implications

After ossiculoplasty, it may take around 6 months for the patient to regain good hearing. This procedure may damage the surrounding nerves causing facial nerve palsy or sensory hearing loss in occasional cases. The artificial bones may not remain in place and may be extruded out, resulting in further complications.

Ossiculoplasty: Treatment/Procedure

The patient needs to be hospitalized for a day or two for ossiculoplasty. The surgical procedure should only be performed when the patient is fit and healthy for surgery. The procedure is performed under local anaesthesia. The region behind the ear is incised, which follows into the mid portion of ear, and the damaged ossicular bones. These bones are then replaced by artificial bones and positioned correctly before closing the incision. If the bones are not damaged extensively, then they are repaired and placed in a favourable position to aid hearing. It is a low-risk surgery and the patient is generally discharged the same day.