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mspgh 08-12-2013 11:38 PM

Second Stapedectomy Report 8/12/13

I had a second stapedectomy the morning of 8/12/13, this time in my left ear.

For the benefit of anybody that came to this forum like I did, i.e. simply looking for information, or better yet, detailed first hand accounts of what its like to go through a stapedectomy operation and subsequent recovery, I thought it would be beneficial to share my experience(s).

Recovery progress of my first (right ear) stapedectomy is posted in this thread:

All the details are in that thread, but I'll sum up the experience by saying it was a tremendous success. It was performed by Dr Berenholz at the Lippy Clinic in Warren in OH and I am abut 18 months post-op. My audiogram now shows the hearing in my right ear to be in a normal sensitivity range up to 8KHz (which is as high as they test), and in fact there was some over-closure of the air-bone gap.

The left ear stapedectomy was again peformed by Dr Berenholz at the Lippy Clinic in Warren OH. So far all signs indicate a successful procedure. The hearing test that was immediately administered post op showed improvement at 500Hz & 1000Hz. So far my recovery experience has been similar to the right stapedectomy from February of last year, with a few key differences...

First of all, I can remember the procedure this time and I was partially awake during surgery! I remember the hearing test, the sucking and scraping noises; not in great detail, but I was semi-conscious and I do actually remember laying on the table while they were working. I dont remember any of that from the first time. Being awake during the surgery was not pleasant, but not terrifying either; it was in between, sort of like getting your teeth drilled and filled at the dentist office. I would have rather been sedated a bit more but I toughed it out. I chalk this up to a different anesthesiologist perhaps? Generally, I feel that they didn't dope me up nearly as much this time. Not a major complaint or a deal-breaker, but not what I was expecting. I think a partial trade off here is that I felt much much better and more alert almost immediately and I wasn't as groggy in the 24 hours or so after the operation.

The second major difference (and this is a big one): I am experiencing NO vestibular symptoms this time around (yet). No dizziness, no vertigo, in fact I feel pretty close to "normal" physically, at least I feel much better than I did after the first procedure. So far this has been a pleasant surprise. I believe this might be due to the fact that the condition was not as advanced in my left ear, so the surgeon didn't have to do as much work to free up the footplate resulting in less disturbance to the inner ear, however that is a bit of a guess so don't take it as gospel. Dr Berenholz is also a very skillful surgeon so it could be due to the fact that he is just that good.

Other than that, my recovery so far is mostly consistent with the experience I had with the right ear: there is a good amount of bleeding; there is some ringing tinnitus which seems to come and go; some pulsatile tinnitus which also comes and goes; there is mild pain and discomfort (tylenol + codeine takes the edge off). The ear is completely blocked up with gelfoam, clotted blood and swelling so I'm not getting any sound through the ear yet but I am picking up vibrations on that side of my head so I dont believe the nerve is damaged. Having been through the healing process once already, I more or less know what to expect, so I think this start to clear up over the next few days.

More to come as I heal. Hope somebody out there finds this to be helpful!

mspgh 08-14-2013 11:58 AM

Re: Second Stapedectomy Report 8/12/13
About 48 hours post op... no major changes in hearing yet. Actually I feel a little bit woozy today, with some mild dizziness or light-headedness, but I'm sure its nothing to be too concerned about... some low frequency sounds are getting through in the operated ear but it hasn't started to open up yet. tinnitus comes and goes... Sounds are pretty loud in my head, like my electric toothbrush, and its equally loud on both sides, so that would indicate the nerve is functioning well. getting a little bit impatient, trying to take it easy...

mspgh 08-19-2013 08:24 AM

Re: Second Stapedectomy Report 8/12/13
Day 7 Update...

No major changes yet. I went back to work today.

Tinnitus continues, on and off. It varies from very high pitched tones to some mid-range frequency tones. I expect it will slowly taper off as the ear heals, the packing dissolves, and the hearing improves in the mids and highs.

Some mild dizziness persists, but I never experienced the extreme vertigo like the first time. This time it was more like the feeling you get after you had one too many drinks. Walking and general physical exertion seems to exacerbate it. There is also some mild pain and pressure in the ear, sort of like how an ear infection feels. It also comes and goes.

The ear stills feels really blocked up so the hearing is very muffled, although I am starting to experience the extreme sensitivity to loud sounds. I remember this from the last time. I can tell that some low frequency sound is getting through on that side, but I'm starting to get a little bit impatient while waiting for improvements in hearing. I am not noticing the dramatic improvements that I noticed last time. However one major difference this time is my point of reference: normal hearing in my right ear. I am not hearing new sounds because I can already hear them in my good ear. Last time my only point of reference was an ear with about a -35dB impairment, so I noticed new low frequency sounds right away.

Sound inside my head seems very loud. It actually seems louder on the left (operated) side.

I expect more changes this week.

mspgh 08-22-2013 07:36 AM

Re: Second Stapedectomy Report 8/12/13
Day 10 Update...

I still continue to feel better physically. The minor equilibrium disturbances I experienced this time around are pretty much gone. Any mild ear pain/discomfort is pretty much gone as well. I have had a few headaches the past few days but I dont think they are related to the stapedectomy (probably due to my caffeine intake).

The packing is starting to loosen up and move around in my ear canal. Sometimes if I pull on my earlobe the right way the ear becomes unblocked for a second and my hearing opens up and it gets very loud on that side. Then the packing moves and blocks up my ear canal so the sound gets all muffled again. Its kind of driving me crazy and I REALLY want to get the packing out but I know I have to be patient. If its like last time my hearing will become "open" more often on its own as the packing dissolves away.

Tinnitus is pretty bad (annoying!), but I'm pretty sure that wont be a problem once the packing is gone.

My hearing seems to be slowly improving. I can definitely hear more low frequency sounds on that side. I can use the phone on that ear, even with the packing in, although its very muffled. For the few brief moments when my hearing has opened up, the sound had a blaring, loud, distorted quality to it, which I think is normal. I more or less experienced the same thing on the other side and it kind of slowly corrected itself.

All good signs so far. Feeling positive about the results!

mspgh 08-25-2013 03:38 PM

Re: Second Stapedectomy Report 8/12/13
Day 13 Update...

Almost 2 full weeks and so far so good. So far the recovery seems to be progressing a little bit faster than my first stapedectomy.

Last Thursday my ear sort of "opened up" at work and since then it has pretty much stayed open. I can still sort of feel the packing lodged in my ear canal, and at times it sort of blocks some sound but for the most part I can already tell that my hearing is very much improved overall.

The mids and some high frequencies are getting through, although the extended high frequencies are not there yet. If I had to guess, I would say my hearing starts to drop off around 4-6kHz. The higher frequencies that I actually can hear sound a little bit artificial at times, like the artifacts you hear in a low bitrate mp3, but I anticipate this to diminish over time.

The operated ear is sensitive to loud sounds; with headphones, music sounds louder on that side, with a sort of blaring midrange, although this is probably temporary.

I am experiencing basically no dizziness or vestibular symptoms of any kind. I feel pretty good physically, although physical activity does tend to create some pressure in the ear, like a feeling of fullness, and it makes my ear pop. So I have to remember to take it easy.

Some tinnitus persists, but its slowly tapering off and its getting drowned out by real external sound from the outside world. The lower pitched ringing that sounds like guitar feedback is definitely going away. The high pitched hiss is still there, although at times I can't tell if the sound is in my head or if I am actually hearing crickets & other insects in the yard, especially at night. I expect it all to go away as high frequencies improve...

I live on a hill overlooking the city of Pittsburgh. After my first stapedectomy last February, I realized that I could hear the city at night when I would leave the windows open. It just sounds like white noise most of the time, with the odd car or motorcycle engine rising above the background din. But I could really only hear the white noise "city sound" with my fixed (right) ear, so if I would roll over and lay my right ear on the pillow, I wouldn't actually hear the city anymore, I only heard crickets in the yard. Now, I can hear the city sound no matter which side of my head is on the pillow, and let me tell you, that is a great feeling. Not only that, when I listen with both ears, I think I can actually hear more detail in the city sound. Like its not just white noise anymore, but I can pick out individual car engines, and voices echoing up from the valley.

mspgh 09-03-2013 01:07 PM

Re: Second Stapedectomy Report 8/12/13
Day 22 Update...

My recovery continues. I started to put the peroxide drops in the ear to dissolve the blood and the packing, and i could hear all kinds of crackling and popping like a bowl of Rice Krispies (just like last time). I'm a few days ahead of schedule with the eardrops- I actually wasn't supposed to start them until Friday but I got a little bit anxious. The same day I first used the drops, my ear seemed to pop and get blocked up a little more than usual and I also noticed some intermittent dull pain and pressure that went on and off for about an hour that afternoon. I dont think this is anything to be concerned about though, probably just some drainage of fluid or whatever else is in my ear canal that got loosened up by the hydrogen peroxide.

The past week, as the ear has been healing, it has sort of felt like how the ear feels as a middle ear infection clears up: not much pain, just some mild fullness, like fluid is in the ear canal against the eardrum & hearing seems a little bit dull. This feeling seems to improve a little bit each day.

Ringing tinnitus is barely noticeable at this point. I would go so far as to say its pretty much gone completely. Sitting at my desk at work, it used to drive me NUTS. Today, I don't notice it all. In fact its really only audible in very very quiet environments. I still get the pulsatile tinnitus from time to time but I think that has a different physical cause then the ringing, and I expect it to slowly taper off as the ear heals.

I can already tell that my hearing has improved significantly. The stereo image of sound is much better now and I think I have a better sense of directionality of sound. Everything is really starting to sound the same on both sides so the symmetry is better, although music on headphones still seems a bit louder on the left side. I can hear test tones through headphones up to 10,000Hz on the left (newly operated) side although that particular tone is louder on the right. I am again experiencing that sharp sensitivity to loud sound although its not quite as dramatic as after the surgery on the right ear, probably because the condition wasn't as bad in my left ear and neither was the hearing impairment.

As far as sound quality, it is improving as well. That "un-natural" quality that higher frequencies seemed to have at first seems to be gone now although loud sound gets progressively distorted as volume increases and my hearing on both sides seems to lack the brilliance that it once had. I'm not sure if this is because I lost the ability to hear extended high frequencies (above 12kHz) or if its because my sensitivity to mids and lows has improved so much. In any case, I'm not too worried about it because I will get used to it and I can hear so much better overall.

I feel fine physically. No dizziness at all. Totally back to normal, 100%. I am going to start some light exercise this week now that I am in the clear for some physical activity (Dr said to wait 3 weeks). Tomorrow I'm going to start biking to work again, but other than that I'm not going to try anything too intense until after my follow up visit next week.

I'll post another update next week after my follow up Dr visit and the first hearing test.

Fantine 09-11-2013 05:06 PM

Re: Second Stapedectomy Report 8/12/13
I had a stapedectomy in my left ear in April 2011. I have delayed getting the second stapedectomy because I started to experience mouth dryness after the first surgery. My surgeon conserved the chorda tympani nerve during the surgery, but it's possible that the nerve was damaged, resulting in the dryness. It's also possible that I developed an auto-immune disease called Sjogrens syndrome in the mouths after the operation (not caused by the surgery), which lead to the dryness. In any event, I have delayed having the second ear done, making due with my hearing aid. I was wondering if you had any problems with mouth dryness after your surgeries or if your surgeon cautioned you about that possibility? Thanks.

mspgh 09-11-2013 06:49 PM

Re: Second Stapedectomy Report 8/12/13
No I never really had any mouth dryness. At least nothing I would characterize as moderate or sever. There was some numbness and tingling in my tongue, more so after the first procedure, and it went away pretty soon. I think thats fairly common.

I gotta say, I was putting off the second surgery because I thought I was getting along fine after the first one, but wow, its so much better now! I think I gained in the neighborhood of 30dB in the mids and lows, and its made a huge difference. The symmetry is awesome. I haven't heard the world like this since I was a kid.

Fantine 09-12-2013 07:38 AM

Re: Second Stapedectomy Report 8/12/13
I would get the second surgery done in a heartbeat if I wasn't so concerned about the mouth dryness issue. Nobody seems to know WHAT is causing the dryness, whether it's an autoimmune disorder or was caused by some damage to the left chorda tympani nerve. So I'm left on the horns of a dilemma, either leave well enough alone and deal with the diminished hearing and tinnitus I have in my right ear or take the chance of having an even more dry mouth by having the surgery. I have scheduled and cancelled the second surgery now three times, that's how conflicted I am.

mspgh 09-12-2013 08:58 AM

Re: Second Stapedectomy Report 8/12/13
Other than the dry mouth, was it successful? How much did your hearing improve? Were there any other side effects?

If I had to choose between hearing impairment and dry mouth, I would probably choose dry mouth. If nothing else, it seems that a dry mouth is more easily treatable. On the other hand, I don't know how severe your dry mouth symptoms are, so it may be much more unpleasant than I can imagine.

I don't think this is a common side effect so my guess is that the likelihood of similar outcome is low. So there is that to consider.

I also feel that the longer you let otosclerosis advance, the more difficult it becomes for the surgeon to perform. I feel with more advanced cases there are more side effects and the hearing improvement isn't as good. But thats just a lay person's opinion and its not based on any clinical evidence. A doctor would probably have a more educated opinion.

Fantine 09-15-2013 06:48 AM

Re: Second Stapedectomy Report 8/12/13
[QUOTE=mspgh;5222188]Other than the dry mouth, was it successful? How much did your hearing improve? Were there any other side effects?

If I had to choose between hearing impairment and dry mouth, I would probably choose dry mouth. If nothing else, it seems that a dry mouth is more easily treatable. On the other hand, I don't know how severe your dry mouth symptoms are, so it may be much more unpleasant than I can imagine.

I don't think this is a common side effect so my guess is that the likelihood of similar outcome is low. So there is that to consider.

I also feel that the longer you let otosclerosis advance, the more difficult it becomes for the surgeon to perform. I feel with more advanced cases there are more side effects and the hearing improvement isn't as good. But thats just a lay person's opinion and its not based on any clinical evidence. A doctor would probably have a more educated opinion.[/QUOTE]

The left ear stapedectomy was very successful, and I know have normal/borderline hearing in that ear. Don't downplay how bad dry mouth is. If it's severe, you get cavity after cavity after cavity and gum disease to the point where you end up losing all your teeth, but you have trouble with dentures because you need saliva to get dentures to stick to your gums. Dry mouth causes far-ranging health consequences, including digestion issues due to the lack of saliva, that hearing impairment does not. But you're right that damage to the chorda tympani nerves due to stapedectomy is not a common side effect.

Etty2385 09-15-2013 10:29 AM

Re: Second Stapedectomy Report 8/12/13
Hi! I just had a question about stape. Surgery recovery. I understand that you can't really bear anything during recovery because of the packing and blood cloths (I can bear when I rub my ear and cotton tho) buy could someone explain to me high and low frequencies? Like what those are?

Also am I supposed to be on bed rest for an entire week? I know I can't go to work. But can I go to the store etc?

Another thing is that I never used to have ringing or drum like noise In my ear and now I do. I understand that it could be my heart beat because my ear canal is clogged. But could it also be nerve damage. Sinxe tinnitus is a symptom of that? Thank you for reading!

mspgh 09-17-2013 08:28 PM

Re: Second Stapedectomy Report 8/12/13

So I think this is day 36? Not 100% sure actually, but its a little over 1 month. I went for my first post op check up last Friday and everything checked out really well. Just as the first time, my test shows some over closure of the air bone gap. I pretty much could tell the results were good so this was not a surprise to me.

The ear feels good. Its still healing so it pops alot and I have trouble getting it to open some times, or at least it opens slowly. I think this is probably due to some swelling that prevents the eustachian tube from opening and functioning competely normally. I expect it to subside in time as the right ear did.

All in all, I think the results are great. I actually didn't expect such great results because I didn't think this ear was as bad I didn't need the surgery as much but its been very noticeable, especially when it comes to music.

I look forward to a time when a whole day will go by and I wont even think about my ears a single time! Its been a long time...

Marie 67 10-08-2013 02:00 PM

Re: Second Stapedectomy Report 8/12/13
Would you recommend Dr. Berenholz to someone else that was considering having ear surgery? What is the Lippy Clinic? My family and I live in Columbus, Ohio. Where is Warren? Isn't it down close to Cincinnati? Is this where the Lippy Clinic is? I made a post a few weeks ago wanting a recommendation to a good surgeon but I haven't received one reply. I hadn't come across your post at that time. I've read that it makes ALOT of difference on the outcome of one's surgery if your surgeon has alot of experience and does the kind of operation frequently that you're having. Would you agree? Are there different types of prothesis available to choose from? I thought I read about someone with a titanium one that was recommending that kind. But I'm not 100% sure that I'm remembering it correctly and I can't find the post. I do remember that it was made out of some type of metal? What are others made of? Do you mind telling why you had surgery?

mspgh 10-09-2013 08:57 AM

Re: Second Stapedectomy Report 8/12/13
Yes, I would definitely recommend Dr Berenholz. The results of my stapedectomies are absolutely amazing. Google "Lippy Group" to find info about the practice (sorry, the forum doesn't allow me to post direct links).

I had the surgery because I was losing my hearing due to otosclerosis and I didn't want to use hearing aids. This was a personal decision for me, but the two main factors in that decision were: (1) I am a musician and an amateur audio engineer. The use of a hearing aid would have probably been the end of my audio engineering work, and (2) I felt that a hearing aid would only treat the symptom not the underlying condition. Furthermore, if left un-corrected by surgery, otosclerosis can eventually cause permanent sensorinearual hearing loss, and I was at a point were bone conduction tests still showed good auditory nerve function and sensitivity. So surgery had a big potential upside for me and although I knew there was some risk, I was willing to accept it.

Warren is near Youngstown, so its a couple hours from you in Columbus. I don't know of any surgeons in your area, but I felt Dr Lippy and Dr Berenholz were better options than any other surgeons I found in Pittsburgh. We do have world class medical care with UPMC right here in town, but for this particular condition and this particular procedure, I felt Dr Lippy and Dr Berenholz were the best choice for me.

Yes, I strongly agree, as do many others, that you should find an experienced surgeon to perform this procedure. Find the most experienced surgeon you can. I think it increases the chances of favorable results and reduces your chances of complications and side effects. I chose the Lippy Clinic because otosclerosis is one of their specialties and between Dr Berenholz and Dr Lippy, they have performed over 10,000 stapedectomies. I was very confident in their abilities. ...Just a personal anecdote on this topic: An acquaintance of mine from Chicago also had stapedectomies on both ears. The first procedure was performed by (in his words) "a general ENT guy" who had maybe done a few hundred stapedectomies and the second was performed by a specialized surgeon who had done several thousand. The results of the second were much much better, and the last time I talked to him about it, he was considering a revision procedure of the first stapedectomy that had less than stellar results.

I have a titanium Robinson prosthesis in both ears, which are MRI safe. Titanium is a strong lightweight metal that is used in many medical/surgical applications (implants, surgical instruments, etc...). I think there are several types of prostheses in use (different materials, different shapes), in fact I believe Dr Lippy has even developed his own prosthesis. Your surgeon should be able to answer more detailed questions about the types of prosthesis that they use.

By the way, don't feel bad if you don't get too many responses to a thread. The board doesn't have alot of regular posters. People tend to come here looking for info and move on when they are done. Hoever, the forum archives are full of info, so I would suggest that you read through them.

akisa 10-29-2013 04:08 PM

Re: Second Stapedectomy Report 8/12/13
Can u tell what were your preop and post op air and bone conductive(in db) thresholds ? I have bone conductive hearing loss on right ear due to translocation or fraction of the stapes. So its not otosclerosis but air bone gap is pretty big, about 35db with sensoneural hearing being normal and bone conductive threshold at 10db vs 45db with air conductive hearing. I am considering laser surgery maybe i heard its more efficent, is that what u did also?
Best regards

Fantine 11-01-2013 07:53 AM

Re: Second Stapedectomy Report 8/12/13
I know that with otosclerosis, the general consensus is that the bone gap should be at least 20-25 dB before you are a candidate for a stapedectomy. My surgeon closed a 30 dB bone gap in my left ear with the stapedectomy.

akisa 11-01-2013 11:17 AM

Re: Second Stapedectomy Report 8/12/13
I am glad your surgery went well. I guess it depends from the surgeons skills and where's the problem in the ear. 30db improvment is pretty good result. Do you maybe know is it possible to see ossicular chain condition from an MR image before i make the decision to do the surgery.

Fantine 11-01-2013 11:40 AM

Re: Second Stapedectomy Report 8/12/13
[QUOTE=akisa;5238269]I am glad your surgery went well. I guess it depends from the surgeons skills and where's the problem in the ear. 30db improvment is pretty good result. Do you maybe know is it possible to see ossicular chain condition from an MR image before i make the decision to do the surgery.[/QUOTE]

I don't know about an MRI, but my surgeon sent me for a CT scan after he suspected otosclerosis. The radiology report said there was no evidence of otosclerosis, but the surgeon called me a few days later and said that he could see the otosclerosis on the scan and recommended that I have bilateral stapedectomies.

Narue 11-14-2013 05:00 AM

Re: Second Stapedectomy Report 8/12/13
May I ask you some questions about stapedectomy. What are some of the reasons that they are performed? Are there different reasons that they are done? What happens to the eardrum? Do they go thru the ear or cut on the head? You must be very brave to be able to withstand this? What was your ear condition that you had this surgery? Why do they pack the ear like they do? Does the packing ever not totally dissolve in the ear and like stay in there indefinitely? I would be so scared. What is the packing made of? I have something I might call an echo in my ear but am not sure if that is what it is. Do you mean a vibration in the ear when you speak or an actual echo like where you hear the word said a second time? I'm just wondering if it is the same thing that I have. Do they remove all the ear bones when they do this surgery? What prothesis types are available and which is best? What are they made of? Thank you for sharing.

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