Stapes surgery after inner ear fenestration

In the case of failure of the inner ear fenestration, sacral surgery can also be performed. Treatment of diseases: otosclerosis Indication 1. After the window is opened, the air conduction is further reduced, and the gas bone conduction difference is above 30dB. The window through the mastoid cavity was closed and the fistula test was negative. 2. Preoperative examination of the non-invasive surface of the mastoid cavity and no infection. 3. The hammer handle has good mobility. 4. The upper bony drum ring exists after the drum ring, and the middle ear cavity is inflated with good tympanic membrane tension. Preoperative preparation 1. Ear 3d with 4% boric acid before surgery. 2. 1d before surgery, the hair around the ear is about 3 ~ 4mm hair, clean the external auditory canal with 75% ethanol, put the sterile cotton ball in the external auditory canal or wrap with sterile dressing. 3. Low-pressure enema one night before surgery, the mentally ill sedative phenobarbital (luminal) 0.09g or diazepam (diazepam) 5mg. 4. Local anesthesia or general anesthesia, fasting and water-free in the morning. 5. Take phenobarbital 0.09g half an hour before surgery, and underwent subcutaneous injection of atropine sulfate 0.5mg. 6. Intramuscular injection of penicillin 800,000 U, 2 / d before surgery. Surgical procedure 1. Incision cuts the upper wall of the external auditory canal, expands, and makes an incision in the ear canal under the microscope. It starts from 6 o'clock and cuts upwards from the back. It is beyond the facial nerve and the outer semicircular canal and ends above the short bone. Deep bones. 2. Separating the flaps The thin strips are separated from the bone surface by the stripper. The skin flaps can be separated at the bone defect of the bone labyrinth or the soft tissue is trapped. Do not apply downward force. Although the outer semicircular canal is closed, there is a possibility that the bone piece will pick up the facial nerve that damages the membrane and the defect of the bone tube when pressed down or squatted. It is divided into the tympanic membrane annulus and enters the middle ear cavity from below. 3. Flip the external ear canal flap of the tympanic membrane, push or lower the tympanic cord downward, expose the trailing edge and the inner side of the hammer stem, make a slit at the trailing edge of the hammer stem with a small knives, separate the tympanic membrane and the hammer stem to form A bone under the capsular bag, in which the hammer shank is located for the purpose of installing the artificial tibia. 4. Remove the structure of the humerus, measure the distance from the hammer stem to the humeral foot plate, and make the artificial tibia of the metal fat plug or the wire Tefoln column according to the length, generally 5.5 to 6.5 mm. Before the foot plate is removed, the metal ring of the artificial tibia is placed into the hammer shank, and the other end is moved forward to the front of the tympanic cavity near the eustachian tube mouth, and after the foot plate is removed, it is moved to the vestibular window; if it is a thick foot plate, Grind into a dish shape, make a small window in the center, insert the steel wire Teflon piston artificial tibia, which is 0.5mm longer than the measured length. Or use the same kind of hammer bone to connect between the vestibular window and the hammer stem. 5. Tighten the metal ring that fits into the hammer stem to the hammer stem. The metal ring is moved as far as possible to the neck of the hammer to make it difficult to slip. Prevent the artificial tibia from coming into contact with the surrounding tissue and cut the tympanic membrane. The humerus foot plate is completely or partially resected with the same humerus surgery, and the artificial humerus is connected between the hammer stem and the vestibular window. 6. Respond to the tympanic ear canal flap filling cavity. complication 1. When the skin is torn and the tympanic membrane of the external auditory canal is not applied, the Thiersch skin can be taken from the forearm or thigh. Trim into a rectangular shape with one end aligned with the tympanic membrane and the remainder covering the window and adjacent the mastoid cavity. 2. The perforation of the tympanic membrane should be repaired by the fascia lining method. 3. Lost trauma or infection This is a serious complication, leading to loss of inner ear function. If the tear of the membrane is minimal, and there is no bleeding or infection, it can heal itself and the hearing can still be improved. Careful manipulation under a 10 to 16-fold surgical microscope can reduce or avoid such complications. 4. Patients with labyrinth syndrome have different degrees of vertigo after operation. Because of the mechanical stimulation of the membrane labyrinth during window opening, the perilymph fluid flows out, and a small amount of blood enters the perilymph space to cause a labyrinth reaction, which is called labyrinth syndrome. If the reaction does not decrease after 3 days, it will increase, and it will not be relieved for 2 to 3 weeks, and the hearing will decrease. It should be considered as serous labyrinthitis, and actively give anti-inflammatory treatment to prevent the development of suppurative labyrinthitis. If there are signs of suppurative labyrinthitis, broad-spectrum antibiotics should be given; for those with meningeal irritation, if necessary, it is possible to get lost and diverted for drainage. 5. Facial injury in the facial nerve injury, facial paralysis can occur immediately; accidentally injured part of the exposed nerve sheath, will gradually edema in the facial nerve canal, compression of nerve fibers, late facial paralysis, according to the extent and nature of the damage. 6. Lost water Shambaugh has pointed out that 12% of the ear is lost in the months after surgery to several years, may be the membrane lost to the surgical product histamine allergy. Symptoms include sudden drop in hearing of the ear, fluctuations, tinnitus, dizziness, and nausea in the ear. To prevent the occurrence of lost water, steroids and low-sodium diets can be given. For those with severe dizziness, sedatives or antihistamines can be given. Drugs.

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