Stapedectomy

Dr. Paul F. Shea |  Blog on Stapedectomy | NOVEMBER 13, 2014

Stapedectomy is an operation that is performed on patients with a disease called “otosclerosis” to restore their hearing. This condition causes a progressive loss of hearing, in one ear or both, from fixation or “stiffening” of the stapes, one of the tiny bones in the middle ear that connects the eardrum to the inner ear. Sound is essentially vibration in the air. The hearing loss caused by otosclerosis is the conductive type, primarily, meaning that the sound is not able to get into the inner ear, where it is converted into signals to the brain, as opposed to “sensorineural” loss, or “nerve deafness”, which is due to a loss of nerve endings within the cochlea. We do not know why this condition afflicts some people, but is runs in families about 50% of the time.

The stapedectomy operation is performed through a microscope by an otolaryngologist (ear, nose, and throat or ENT surgeon). It is considered to be one of the most technically challenging operations in the field of otolaryngology, and many ENT surgeons are not comfortable performing the procedure, and refer patients with the condition to an otologist (ear specialist).

The stapedectomy operation was invented by my father, John Shea, Jr., M.D., in Memphis, Tennessee in 1956. To say that it was “revolutionary” is an understatement. It literally changed the course of modern otology. Stapedectomy had been attempted in the past, both in Europe and the United States, in the late 1800’s, but never with good results, and was abandoned and even condemned by the medical establishment around 1900 as dangerous, ineffective, and unsafe. For a young ear surgeon, as my father was in 1956, to attempt to do a procedure that all the textbooks said could not be done, was ambitious, to say the least.

My father went to Vienna, Austria, in the early 1950’s, and studied German medical texts from the late 1800’s, to learn what had been tried previously with stapedectomy. He recognized that in order to restore the hearing of patients with otosclerosis, the diseased stapes bone would have to be removed, that the chain of tiny middle ear bones would have to be reconstructed with an artificial bone, and that the fragile inner ear would have to be sealed with tissue in order for the operation to be successful. No one before had understood the importance of all the steps that were necessary to achieve success. It helped that several other technological inventions had come along by that time, including microscopes with illumination and a biocompatible plastic called “Teflon”, which is what the stapes prosthesis was made from.

My father faced fierce opposition from the medical community for his bold early attempts at stapedectomy, but the results were undeniable. For the first time, patients afflicted with otosclerosis could have their hearing restored safely and reliably. Slowly, the operation caught on, and now, nearly 60 years later, it is performed worldwide, with few changes, and is considered the standard of care in the surgical treatment of otosclerosis. Patients travelled from all over the world to have my father restore their hearing, and it put the Shea Ear Clinic on the map. My father went on to perform some 25,000 stapedectomies in his career, more than almost anyone else in the world.

Otosclerosis is far less common today than it was in my father’s day, as most of the patients with the disease have already been treated, so it is not performed nearly as often as it used to be. However, we still see a fair number of patients with the condition at the Shea Ear Clinic, and perform the operation routinely in much the same fashion as it has been for over 50 years.

I was trained to do stapedectomy by my father. Recently, I had occasion to review my own personal results from stapedectomies that I have performed since I began practice at the Shea Ear Clinic. Results are evaluated by comparing the audiogram (hearing test) of a patient before a stapedectomy to their audiogram after the surgery. Bear in mind that the procedure entails significant risk of the hearing being worse, and is technically difficult, which is why few ENT surgeons will even attempt it. I have performed 92 stapedectomies since 2002 for which adequate information was available. 89% of them had improved hearing, and 67% of them had results that were judged to be “excellent”. Approximately 9% were judged to be the same, and only 2% were worse. None were deaf.

If you or someone you know has otosclerosis, or thinks they might, I would recommend they visit the Shea Ear Clinic for a consultation.