Guest guest Posted September 16, 2003 Report Share Posted September 16, 2003 Hi Ingrid Thanks for your response. You certainly sound as if you've been through plenty yourself, especially since I know what trouble face paralysis is. I sincerely hope that you get the 'happily ever after' part of ctoma book eventually. I haven't really gone into the stapes footplate business with my doctor - I'm not entriely convinced that that's going to happen. Basically he says that it will always be a problem if it's missing. Something has to sit against the Oval Window to replace it. I guess what he's telling me is that it would never be as good as the real thing. Good luck with it all Phil Phil Hi Phil, I had my Stapes Footplate and all ear bones destroyed by C-Toma. In January (1st surgery with previous Dr). I had surgery to remove what infection the Dr could find and a plastic mesh graft to replace the Stapes Footplate. If all would have went fine, the plan was to make sure the graft held for 6 months and then do the reconstruction surgery. Unfortunately for me, the previous Dr put the graft on top of the C-Toma he missed and I ended up with another surgery on July 7th. All had to be removed. My new Dr says that he can also replace the Stapes Footplate, that is when he is sure that all of the C-Toma is gone. He also says that he would create the Stapes Footplate in one surgery, make sure it held and then dot the reconstruction. This may just be my case, I don't know At this state I also have facial paralysis. Since I am just 9 weeks out from my last surgery, he is just watching me at this point. I had an MRI on my Brain and 7th nerve (Facial Nerve) that showed I again have something going on in the middle ear (fluid, inflammation) and around the facial nerve. I was put on Prednisone for 2 weeks to see if the fluid and inflammation would go away. I see the Doctor again in a week and find out what the next chapter is. Foe me to handle to this, I have to handle it like each incident is a chapter of a book and eventually I will get to the ending. (Hopefully, Happy ending) I have not been through as much as you and just want you to know that you have been a tremendous help to me with all of your knowledge and experience. I am sorry for all of us that have been forced to be knowledgeable on this Subject. Ingrid -----Original Message-----From: Phil [mailto:psmorris@...]Sent: Monday, September 15, 2003 6:57 PMcholesteatoma Subject: Re: New members hello My doctor has also suggested to me that that he can reconstruct an ear which has had a full radical mastoidectomy. This ear hasn't had an eardrum or ossicles since I can remember - there's also a damaged facial nerve and somehow the bottom of the ear is missing. I also have a fairly immovable ctoma embedded in the bone throughout both ears. Next month I'm going in for 'temporal bone resection' surgery as an attempt to eradicate the disease. It's a yet more radical surgery that basically removes the ear canal and middle ear completely and therefore the ear has to be rebuilt from scratch. It's hoped that grafting entirely new skin will get rid the ctoma for good. If that works, the doctor says he might as well try to reconstruct the ear at the same time by grafting an eardrum and using prosthetics. There's no stapes footplate (something I don't think can be replaced) and so the hearing won't be very good if it works at all. It's an ear that I've never heard out so anything would be a bonus. If all this is successful the doctor will then do the opposite ear which isn't really so bad as this one. Like , I think that if surgeons can reconstruct my ear then they can probably fix any. It's a bit experimental it seems, so I think I'll wait to see if I wake up with a new ear at the end of it. Phil Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Hi Phil, I am really interested in what your Dr has to say about the Stapes Footplate. I have only been seeing my new Doctor 6 weeks and he is still trying to get a handle on my situation. I am still learning myself here, but can you tell me more about the Oval Window? Is your surgery going to correct your facial paralysis? Ingrid -----Original Message-----From: Phil [mailto:psmorris@...]Sent: Tuesday, September 16, 2003 2:58 PMcholesteatoma Subject: Re: Phil-Ingrid Hi Ingrid Thanks for your response. You certainly sound as if you've been through plenty yourself, especially since I know what trouble face paralysis is. I sincerely hope that you get the 'happily ever after' part of ctoma book eventually. I haven't really gone into the stapes footplate business with my doctor - I'm not entriely convinced that that's going to happen. Basically he says that it will always be a problem if it's missing. Something has to sit against the Oval Window to replace it. I guess what he's telling me is that it would never be as good as the real thing. Good luck with it all Phil Phil Hi Phil, I had my Stapes Footplate and all ear bones destroyed by C-Toma. In January (1st surgery with previous Dr). I had surgery to remove what infection the Dr could find and a plastic mesh graft to replace the Stapes Footplate. If all would have went fine, the plan was to make sure the graft held for 6 months and then do the reconstruction surgery. Unfortunately for me, the previous Dr put the graft on top of the C-Toma he missed and I ended up with another surgery on July 7th. All had to be removed. My new Dr says that he can also replace the Stapes Footplate, that is when he is sure that all of the C-Toma is gone. He also says that he would create the Stapes Footplate in one surgery, make sure it held and then dot the reconstruction. This may just be my case, I don't know At this state I also have facial paralysis. Since I am just 9 weeks out from my last surgery, he is just watching me at this point. I had an MRI on my Brain and 7th nerve (Facial Nerve) that showed I again have something going on in the middle ear (fluid, inflammation) and around the facial nerve. I was put on Prednisone for 2 weeks to see if the fluid and inflammation would go away. I see the Doctor again in a week and find out what the next chapter is. Foe me to handle to this, I have to handle it like each incident is a chapter of a book and eventually I will get to the ending. (Hopefully, Happy ending) I have not been through as much as you and just want you to know that you have been a tremendous help to me with all of your knowledge and experience. I am sorry for all of us that have been forced to be knowledgeable on this Subject. Ingrid -----Original Message-----From: Phil [mailto:psmorris@...]Sent: Monday, September 15, 2003 6:57 PMcholesteatoma Subject: Re: New members hello My doctor has also suggested to me that that he can reconstruct an ear which has had a full radical mastoidectomy. This ear hasn't had an eardrum or ossicles since I can remember - there's also a damaged facial nerve and somehow the bottom of the ear is missing. I also have a fairly immovable ctoma embedded in the bone throughout both ears. Next month I'm going in for 'temporal bone resection' surgery as an attempt to eradicate the disease. It's a yet more radical surgery that basically removes the ear canal and middle ear completely and therefore the ear has to be rebuilt from scratch. It's hoped that grafting entirely new skin will get rid the ctoma for good. If that works, the doctor says he might as well try to reconstruct the ear at the same time by grafting an eardrum and using prosthetics. There's no stapes footplate (something I don't think can be replaced) and so the hearing won't be very good if it works at all. It's an ear that I've never heard out so anything would be a bonus. If all this is successful the doctor will then do the opposite ear which isn't really so bad as this one. Like , I think that if surgeons can reconstruct my ear then they can probably fix any. It's a bit experimental it seems, so I think I'll wait to see if I wake up with a new ear at the end of it. Phil Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Hi Ingrid This is great! Where else could you have a discussion about stapes footplates? I've been trying to find more info on the web without a great deal of success. All I know is that the stapes (meaning 'stirrup' because of it's shape)is the last, furthest in and smallest of the three occicles - and it really is very tiny. It's made up of an arch shape and a footplate - the footplate is a little piece of bone that sits on the Oval Window, which is a small membane that covers the opening of the cochlea where sound is actually registered. I think the stapes acts like a little piston, transmitting vibrations into the inner ear. There are prostheses to replace the main bit of the stapes but they seem to require a footplate to latch on to. I haven't yet found any information that talks about replacing the footplate part. Maybe you could ask your doctor for more detail. The stapes footplate seems to be the last part of the ossicles to erode. I lactually lost the hearing bones in my worst affected through previous ear disease long befoe ctoma came along. Anyway, it's all ifs and buts for me - I'm not too concerned about the hearing since I've been without it for a very long time now. The main aim of the surgery is to try and get rid of the ctoma which I understand is just about everywhere in the ear canal and middle ear etc. I would hope it would help with the facial paralysis, that seems to give me more and more trouble, it's affected the movement of my mouth and face but thankfully not yet my eye. The doctor will try to repair the nerve once he's removed the ctoma that's entwined around it. And there's a bit of a balance thing to sort out too. Lots of little chapters in the book for me too. Phil Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2003 Report Share Posted September 18, 2003 HI Phil, Here is what I have read about replacing the Stapes Footplate: Surgery Good surgical candidates are those patients in whom the Rinne test is negative (bone conduction greater than air conduction with 512 Hz tuning fork) and preoperative bone conduction levels are between 0 and 30 dB. In conventional Stapedectomy, the head of the stapes is separated from the incus, and the stapedius tendon is cut. The crura and footplate of the stapes are removed, and a lobule of fat harvested from the earlobe is fashioned to fit the oval window. A stapes prosthesis is inserted into the oval window, then crimped around the incus. In laser stapedotomy, a laser is used to vaporize the stapedius tendon and the posterior crus of the stapes and to create a tiny opening in the footplate. Once the anterior crus is removed, a wire Teflon piston is inserted into the small opening in the footplate and tightened around the long process of the incus. Small pieces of fat are positioned around the piston to seal the inner ear. In 95% of patients, hearing improves after surgery, but this depends on the degree of preoperative sensorineural hearing. This is what I had supposedly had done in January. The Stapes Footplate was made from me outer ear (just inside the outer ear on the edge going into the ear canal , right next to my face). I had 2 stitches where they removed the lobule of fat that made the Footplate. The Footplate was made with a plastic mesh graft (supposed to stop scar tissue) and the fat from the earlobe. Needles to say for me, the footplate was put on top of the C-Toma that was removed in July. I may be in the same chapter as you, the facial paralysis is what has my new Dr concerned. By the way he is fantastic! Tom Hansen recommended I see the Dr that he used to see when he was here in Nebraska. His Dr and my Family Dr recommended the Dr I am seeing now, Dr Britt Thedinger. His brother is an Otologist also and is the Dr that Tom Hansen sees. My facial problems started with a goofy smile that my husband started noticing. It is like the right side of my face is dragging the left side (left side is the surgery ear). Then one night I noticed that the left half of my left eyelid was numb and my eyelid was half closed. I could not open it any further or shut it. This is still going on with more bad days lately than good ones. That was when I went in and had the MRI. The MRI showed that something was going on with the 7th nerve (facial nerve) in my middle war. I am now starting to get alot of earaches, so who knows what that means. I go back to the Dr on Oct 6th or sooner if the earaches don't stop. The Dr keeps asking me about any drainage in the ear and I have never had any at all. I know that that is one of the key signs, but I have never had any drainage. I also have a bit of a balance problem, drives me crazy!! I have also resigned myself to the hearing loss! All I want is to get the infection out!!! I will send you more info on the Stapes Footplate directly to you and then I will send it to to check it out. Ingrid -----Original Message-----From: Phil [mailto:psmorris@...]Sent: Wednesday, September 17, 2003 2:36 PMcholesteatoma Subject: Re: Phil-Ingrid Hi Ingrid This is great! Where else could you have a discussion about stapes footplates? I've been trying to find more info on the web without a great deal of success. All I know is that the stapes (meaning 'stirrup' because of it's shape)is the last, furthest in and smallest of the three occicles - and it really is very tiny. It's made up of an arch shape and a footplate - the footplate is a little piece of bone that sits on the Oval Window, which is a small membane that covers the opening of the cochlea where sound is actually registered. I think the stapes acts like a little piston, transmitting vibrations into the inner ear. There are prostheses to replace the main bit of the stapes but they seem to require a footplate to latch on to. I haven't yet found any information that talks about replacing the footplate part. Maybe you could ask your doctor for more detail. The stapes footplate seems to be the last part of the ossicles to erode. I lactually lost the hearing bones in my worst affected through previous ear disease long befoe ctoma came along. Anyway, it's all ifs and buts for me - I'm not too concerned about the hearing since I've been without it for a very long time now. The main aim of the surgery is to try and get rid of the ctoma which I understand is just about everywhere in the ear canal and middle ear etc. I would hope it would help with the facial paralysis, that seems to give me more and more trouble, it's affected the movement of my mouth and face but thankfully not yet my eye. The doctor will try to repair the nerve once he's removed the ctoma that's entwined around it. And there's a bit of a balance thing to sort out too. Lots of little chapters in the book for me too. Phil Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2003 Report Share Posted September 18, 2003 Hi Ingrid Thanks for all your infor and search results on stapes, that will provide me with some interesting research for the weekend. 'Lobule of fat' just doesn't sound like a pleasant thing to contemplate, does it? My surgeon hasn't really gone into any detail about reconstruction since he didn't consider a viable option at first and has only recently begun to mention it. The main issue is to try and eradicate ctoma. I was originally diagnosed with ordinary ctoma and a rare form called External Canal ctoma -both were present at the same time. I had an open cavity surgery which did sort the regular ctoma and clear up the drainage I'd had for years. Canal ctoma is much harder to shift because it burows into the bone and is thought connected to some kind of cellular changes in the skin inside the ear which basically means that any skin in the ear canal and middle ear will simply keep turning into ctoma. This is why the doctor has proposed more radical surgery to try and build a ear with new skin etc. Advanced Canal ctoma is particular prone to destroy the facial nerve, though I haven't yet come across any other cases of this. I first got face trouble a couple of years back and it was much like you describe. My mouth would droop and even quiver and my eye would half close and there'd sometimes be a facial tic. It does seem to have settled down now though and is often more of stiffness around the eye and face often with a burning sensation and some jaw trouble. I have managed to avoid any infection for the past couple of years which would have made things a lot worse. Interesting that the surgeon always asks me if there's been any dainage too. Thanks again for the info Phil Hi Ingrid This is great! Where else could you have a discussion about stapes footplates? I've been trying to find more info on the web without a great deal of success. All I know is that the stapes (meaning 'stirrup' because of it's shape)is the last, furthest in and smallest of the three occicles - and it really is very tiny. It's made up of an arch shape and a footplate - the footplate is a little piece of bone that sits on the Oval Window, which is a small membane that covers the opening of the cochlea where sound is actually registered. I think the stapes acts like a little piston, transmitting vibrations into the inner ear. There are prostheses to replace the main bit of the stapes but they seem to require a footplate to latch on to. I haven't yet found any information that talks about replacing the footplate part. Maybe you could ask your doctor for more detail. The stapes footplate seems to be the last part of the ossicles to erode. I lactually lost the hearing bones in my worst affected through previous ear disease long befoe ctoma came along. Anyway, it's all ifs and buts for me - I'm not too concerned about the hearing since I've been without it for a very long time now. The main aim of the surgery is to try and get rid of the ctoma which I understand is just about everywhere in the ear canal and middle ear etc. I would hope it would help with the facial paralysis, that seems to give me more and more trouble, it's affected the movement of my mouth and face but thankfully not yet my eye. The doctor will try to repair the nerve once he's removed the ctoma that's entwined around it. And there's a bit of a balance thing to sort out too. Lots of little chapters in the book for me too. Phil Quote Link to comment Share on other sites More sharing options...
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