Millions of Americans suffer from hearing loss.

Most types of hearing loss are of the inner ear or nerve and can only be treated with a hearing aid. Some diseases, however, affect vibration of the tiny middle ear bones under the ear drum. This creates a mechanical type of hearing loss which can often be successfully treated surgically.

Otosclerosis is one of the most common causes of a mechanical or conductive hearing loss. It is occasionally heriditary but often appears in people without any similar family history. The exact nature of this disease is still unknown but countries with flouride in their drinking water tend have a lower incidence of this disease. Once the disease has occurred, however, flouride supplements seem to be of little help.

Although a hearing aid may be helpful in the early stages of the disease, eventually the hearing loss may become severe enough that an aid is no longer adequate. Furthermore, in some individuals, the disease may affect the inner ear as well. This can result in additional nerve deafness and ringing of the ears (tinnitus).

There are two parts of hearing: mechanical and electrical. The mechanical part picks up sound from the outer ear canal and then vibrates the ear drum and three tiny hearing bones in the middle ear. These are the malleus, incus and stapes - also known as the hammer, anvil and stirrup.

The Eustachian tube is the natural connection between the ear and the nose and throat. It helps ventilate the middle ear as well as the mastoid which is an air-filled honeycomb behind the ear.

The inner ear looks a bit like a snail. It has two halves which are connected and are filled with fluid.

The coil or cochlea takes care of the nerve-part of hearing. Like a telephone, it takes the vibration and turns it into an electric signal that is relayed to the brain.

The other half of the inner ear is the balance or vestibular system. There are three balance canals, each set in a different direction.

In close association to the ear is the facial nerve. It helps move the face and also provides for some of the taste fibers to the tip of the tongue.

At the deepest level is the brain from where the hearing, balance and facial nerves originate.

Normally, the stapes bone vibrates the fluid in the inner. But in otosclerosis, the disease begins to calcify the stapes bone so that it cannot vibrate effectively. At first, the low tones are affected but eventually the hearing loss may affect all the tones.

This diseased bone can be surgically removed and replaced with an artificial piston or prosthesis in a procedure called stapedotomy.

Surgery usually takes 60 minutes and is performed under a local anesthetic with sedation. This allows our patients to feel comfortable and yet be alert enough so that at the end of the procedure we can whisper into the operated ear and find out immediately if the surgery is successful.

The surgery is performed through the ear canal by lifting up the ear drum and working beneath it. A small incision is made behind the ear to harvest some tissue to be used as a seal.

Some of the newer materials today are suprisingly good at fooling the body into thinking that the implant is in fact the patients own natural tissue. As with any artificial implant, however, it is always possible that the prosthesis may become rejected. This may not occur until years after the surgery and would require replacement.

Stapes surgery is the most successful of all operations for hearing loss. But like any treatment it is important to be aware of possible complications.

Any surgery in or around the ear can put at risk many of the structures that reside in this area. Therefore, risks typically include hearing loss, tinnitus, dizziness, infection and perforation of the ear drum. Because of the close relationship of the facial nerve, face weakness is possible but is quite rare. Surprisingly, a small branch of the taste nerve travels underneath the ear drum. This often needs to be moved out of the way during surgery. Therefore, a change of taste along one side of the tongue is not unusual although it often returns to normal. Many patients with otosclerosis have tinnitus or ringing of the ears. Typically this improves a bit after surgery but most patients are advised to expect it to be about the same. Rarely, it may completely disappear after surgery but it is also possible for it to be worse or to originate with surgery.

At our Institute, doctors perform ear surgery exclusively. This experience and the use of lasers help to keep our complication rate extremely low.

In fact, Michigan Ear Institute was one of the first practices in the world to routinely use a laser in ear surgery. It is a particularly important tool during stapedotomy because the inner ear risks of hearing loss, tinnitus and dizziness typically come from trying to chip away the diseased stapes bone using a tiny pick or chisel. With the laser, mechanical vibrations during the most delicate part of the procedure can be eliminated. This is especially important in patients who require revision surgery because the original operation was either unsuccessful or because the piston gradually slipped out of position. Without a laser for such re-do cases, there may be a risk of serious hearing loss even though the goal of surgery is hearing gain

After ear surgery, it is important to keep your ear canal dry for 4 weeks. Use a cotton ball for a day or two but change it frequently. After the first couple days try to leave the cotton out so that the ear can ventilate. For showers, waterproof the cotton ball by rubbing some vaseline jelly on it.

The incision behind the ear is often closed with absorbable stitches. Keep it dry for a week by covering it with a washcloth during showers. Pat it dry or use a hair dryer if it gets wet.

Avoid hard nose blowing which could cause shifting of the piston.

Stuffiness and hearing loss can be expected for some time with any ear operation. This often improve slowly as your body absorbs the healing fluids. In the meantime you can expect to hear inner ear noises and your own heartbeat.

Dizziness is common after this type of surgery. Although lasers reduce severity and frequency of dizziness, be sure to ask your doctor how soon you may return to work or driving.

Stapes surgery is the most successful of all operations for hearing loss. Microsurgical technique and the use of lasers help improve the success rate while reducing complications.

If you have a combined hearing loss due to stapes fixation as well as a nerve deafness, be sure to discuss the alternatives of a hearing aid or the possible need for both surgery and aid to overcome a mixed hearing loss.