A stapedectomy story

One of the most popular posts on this blog to date was in November 2016 when Deb spoke to us about life with her Hearing Dog Elmo.  Here it is, if you missed it.  Knowing that Deb had recently had a big ear operation of her own I asked her if she would write for us again, and here she is……..

“Vera and I have been running along parallel lines with operations and refer to ourselves as sisters-in-recuperation. A week after she had her cochlear implant, I had a stapedectomy. A what? Exactly, so to help shed a little light on this operation Vera invited me to write another guest blog, and here goes.

Before – information gathering and expectations

My age-acquired hearing loss has progressed steadily over the last twenty years or so to the point I am now classed as severe to profoundly deaf. So back in March 2017 at an ENT appointment it was agreed various options should be investigated to see if my hearing could be improved.

In the right ear (perversely shown on the left in audiograms, in red) my hearing loss is down between -80 to -100 depending on the frequency, whereas my bone conduction loss (shown with triangles) is less, between -70 and -40. If all goes to plan, the aim is to improve my hearing closer to the bone conduction level, though it’s unlikely it will improve all that way. Even so it could improve my hearing by almost half which I will happily accept.

How? Via a stapedectomy (pronounced stay-puh-DEK-tuh-mee). This assumes that my stapes is sticking. What’s a stapes? You may have heard it called the stirrup bone, due to its shape. It’s a small bone that sits in the middle ear, behind the eardrum and acts like a piston. As sound waves travel down the ear canal, they hit the eardrum which moves and should compress the stapes which in turn, if it’s working properly, vibrates to transmit the sound onwards to the brain. If the stapes is stuck, which happens for a number of reasons including calcification as you get older, it can be replaced with a little plastic one, a prosthesis. After investigating other options, we decided a stapedectomy was probably my best bet.

After the operation there is a 6 weeks’ recuperation period when I’m not allowed to put in the hearing aid or let the ear get wet – this could be a bit of a challenge. Also I’m not allowed to blow my nose, sneeze or lift heavy objects as this would put too much pressure on the replacement – how do you stop that automatic reflex when your nose runs, especially in winter?!! Another challenge I’m not looking forward to!

So what’s the prognosis?

Best case scenario – my hearing improves to somewhere around the bone conduction level.

Worst case – I lose the minimal residual hearing in my right ear altogether (1% chance).

Medium case – stapes are not sticking so op is terminated and hearing stays the same, hopefully with a slightly shorter recuperation.

My operation will be done in day surgery so no overnight stay unless something unexpected happens. I quizzed my ENT consultant about his experience and he’s done over forty stapedectomies, currently doing about one a week, so he should be well-practiced for me.

The unfortunate thing is there is no way of knowing if the stapes is sticking until he lifts the eardrum. But on balance it seems like a no brainer to have the op.

I had a CT scan to make sure there was enough room in my ear canal to do the op and I had a further hearing test two days before the op so that we could compare before and after. With that, I was ready.

‘E’ Day – the operation

Early start to be at the hospital by 7am, accompanied by Keith and my Hearing Dog Elmo. The latter is a great stress-buster for me, Keith and the many other people with whom we come in to contact, not least the half dozen patients in the day surgery admissions lounge who discovered just what lengths Elmo will go to for a tummy tickle.

Forms filled in, ID label on wrist, said goodbye to my little family (sniff) and in I went. Visited by the anaesthetist’s assistant to make sure I’m not allergic to anything and have all my own teeth, then the surgeon to run through again what would be happening, what the risks are, the hoped-for outcome but with no guarantees, confirm my consent and ask if I have any questions. No – they have all been answered already. He left me with a comely black “tattoo” arrow on my right ear to make sure he got the correct one.

By the time I was wheeled up to the prep room outside the operating theatre I had had my wristband and ID checked eight times and the very friendly porter told me it would be checked several more times in the operating theatre while I was under. Into the anaesthetic room, anaesthetist checked my ID again and explained how she would be monitoring me, cannula in the back of my hand, wall clock said 09.35 and that was it.

Feeling very cold and groggy I came to and focussed on another wall clock indicating 11.35.  My powers of recovery from general anaesthetic seem to deteriorate as my years increase. It was a good two hours before I began to feel part of the world again, able to string more than one word together. At some point in my seemingly endless battle to regain full consciousness I spied my consultant at the end of the bed in the recovery room but I couldn’t keep my eyes open long enough to speak or listen to him before he had to disappear back into theatre. As a consequence I didn’t know if the stapes had been replaced or not, my greatest fear being I would go through the op only to find my stapes is not at least partly responsible for my hearing loss.

I eventually made it back to the day surgery recovery ward but must have taken another hour or so before I felt well enough for tea and toast. In hindsight I’m not sure the latter was a terribly good choice, given a crumb lodged in my throat causing me to cough violently, at which point there was an almighty crackling in my right ear – heavens, please don’t say I’ve undone all the good work on the day of the op!!

The highlight of the day – as ever – was my dear goofy Elmo. As mentioned, he came with me to the admissions lounge and entertained everyone, nurses, patients and visitors as usual. If only there was a way to make a small charge each time he relieves stress and comforts people, I could raise a small fortune for Hearing Dogs! Keith then took him home to await the call to come and collect me. So eventually, when it was time to leave and Keith arrived with Elmo we went through the same procedure – “Oh isn’t he lovely? Can I stroke him? He’s so handsome. What a gorgeous boy” – and that was just Keith!

It’s times like these when I really wish Elmo didn’t cause such a kerfuffle everywhere he goes. I just wanted to go home. Just when I thought we’d escaped and were heading down the corridor, a further three nurses chased after us, asking if they could stroke him. I can’t begrudge them, grotty though I felt. I’m very lucky to have such a secret weapon who slays all before him! Elmo and I are ambassadors for Hearing Dogs when he has his jacket on in public and I feel a duty to raise awareness whenever I have the opportunity – but I really must learn to say no sometimes! He always saves the best greeting for me and doesn’t take his eyes off me. I could almost hear him asking – “Are you OK Mum? I’ve been a bit worried about you”. Keith says when I walk out a door he sits and watches it until I come back – bless his cotton socks.

Four weeks later

Things are going very well. During the three weeks post op when my ear was packed and covered with a dressing, life was very muffled and one-sided and I kept listing to starboard. And to think I used to pay good money to achieve similar!

On the plus side, at night when the other aid was out, I was hearing sounds – Elmo can bark really loudly and fiercely in the middle of the night I’ve discovered. No chance of burglars! However, I have yet to hear him howl as Keith regularly says he does. We think he must be dreaming because when Keith checks, all is fine with Elmo. He is definitely a fidgety sleeper, chasing rabbits or squirrels I guess – not that he sleeps on the bed of course (don’t tell anyone!).

After three weeks I returned to the hospital for my consultant to remove all the dressing. It was a bit like those magic tricks with the endless silk hankies, on and on it went til I began to think there must be no room in my skull for my brain!! And finally the culprit of the yellow staining on my dressings emerged. It was BIPP apparently – a very strong, yellow antiseptic ribbon inserted to improve the healing process. It does however look rather unsightly when the yellow seeps through to the external white dressing which I’d had changed twice in the intervening three weeks to keep up appearances.

We are very lucky with two local community hospitals, what we used to call cottage hospitals, both about five miles, in different directions, from us. Due to the BIPP the dressing soon looked rather unsightly and certainly not the sort of thing I wanted to show up at a job interview with, just one week after my operation (more of which later)! My discharge notes had advised me simply to keep the dressing dry and go to a chemist if I needed a new dressing ……. and then what? Who would take out the old and put in the new? So I’m really very grateful for our cottage hospitals, another part of our brilliant NHS.

Back to the consultant follow-up. After removing the dressing he micro-suctioned my ear. For anyone who hasn’t had this, it’s like a mini hoover sucking debris out of the ear. Very odd sensation though I much prefer this to syringing. Keith advised it wasn’t a pretty sight so I’m glad I didn’t see it. The consultant then declared himself happy with the progress to date and advised I should get another appointment in six weeks (I’m going to get him on Trades Description, as he originally said a further three weeks but I expect the extra weeks are due to the Christmas break) along with a new hearing test. This will likely lead to a less powerful hearing aid for my right ear. I can’t think that I will be able to use the existing one, it will be way too powerful. I have even managed to hear Keith talking to me in the mornings before I put my left aid in. I haven’t been able to do that for ten years!

My biggest challenge in the first few weeks after the operation was a job interview. Wouldn’t you know it, months I’ve been trying to get in to a national organisation and finally I get an interview precisely one week after the op when I still hadn’t fully overcome the effects of the anaesthetic. But I wasn’t going to pass up this chance so I explained the situation to the interviewers before going along and they were very understanding and accommodating. However, three hours later after a full-on, highly structured, competency-led interview with two of the most softly spoken interviewers I have ever experienced, this decision on my part looked rather rash. When Keith asked how it had gone, I said the likelihood of me getting that job is so miniscule I will abseil down Portsmouth’s Spinnaker Tower in aid of Hearing Dogs if I am offered the role! ……… more later.

Sounds

As soon as the dressing was removed three weeks post-op I was aware of improved hearing – magic! Some of my observations – I could hear the consultant talking to his student as he was looking in my ear (the left aid was out) though I couldn’t make out what he was saying. When we got in the car and I slammed to the door, I could feel the pressure in my right ear, it was shocking and weird, having been missing for so long! As we started to drive, I could hear the car rumbling on the road. Early mornings before I put my left aid in, I can hear the cereal packet crackling, the bowl as it touches the worktop, the kettle boiling, the tinkle of the teaspoon in the cup that Vera re-discovered too after her cochlear implant. I can hear the wind blowing over my right ear when out walking Elmo. And – joy of joys – I can hear Keith talking again before I put my other aid in, though I have to concentrate sometimes to work out what he’s saying. Being a Cockney and dropping his ‘aitches has always posed a challenge!

Side effects I’d been warned about included the temporary loss of taste on the right side of my mouth and dizziness, both of which I’ve experienced and certainly acute, momentary dizziness when I hiccup! The taste buds are slowly re-awakening though they are not there yet. It’s like a very long recovery from a dentist injection. One odd side effect I hadn’t anticipated is feeling guilty and a fraud. Can I still describe myself as deaf? Will I still be entitled to keep Elmo? I watched a very moving Channel 4 programme about Teenagers at Deaf School and a young lad trying for Head Boy said something similar, that he felt a fraud and not really deaf because he didn’t use BSL like his fellow pupils. This completely ignored the tremendous effort he put in to working with speech therapists and lip reading after he’d lost his hearing at four due to meningitis.

So just another six weeks of not being able to blow my nose, sneeze or stand under the shower without clingfilm wrapped round my ear, head tilted to keep water away from that side. Still, small price to pay.

Oh and for those of you who are still wondering – miracle of miracles, yes I did get the job, so now am looking forward(!) to the prospect of dangling off a rope 170 metres off the ground on Portsmouth’s Spinnaker Tower in August. Me and my big mouth!

(Deb will be back in a few weeks’ time to tell us about what happened next).

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