Otolaryngologist Severs Auditory Nerve During Surgery

Case Overview

This case involves a sixty-four-year-old male patient who suffered from conductive hearing loss that was preoperatively determined to be due to otosclerosis. The patient underwent a right stapedectomy that was conducted without complication, but postoperatively, the patient reported that his hearing was worse than before any surgical intervention. It is noted in the surgical record that the chorda typani nerve had to be sacrificed and reconstructed around the narrowed bone. The patient was followed for several weeks with no improvement in hearing function, and, at this point, sensorineural hearing damaged was suspected. It was suggested that if no positive results occurred at six weeks post surgery, the patient would likely be a candidate for amplification surgery. An expert witness in audiology was retained for this matter.

Questions to the Plastic Surgery expert and their responses

What does the normal surgical intervention entail?

Approaches to surgical management of otosclerosis include total stapedectomy, partial stapedectomy, and stapedotomy. Hearing improvement can be achieved through surgery for congenital stapes footplate ankylosis with a concomitant ossicular chain anomaly.

What follow-up should be done on this type of patient?

The first postoperative visit is usually scheduled after two weeks, which allows time for the tympanomeatal flap to heal in place. The canal may be débrided at this time. Cotton balls are placed in the meatus two to three times per day to collect discharge from the canal over the first several days after the surgery. Postoperative audiometrics are typically performed three to six weeks after surgery.

About the expert

This fellowship trained plastic surgeon is a fellow of both the American Academy of Otolaryngology and the American Academy of Facial Plastic Surgeons, and is dual-boarded in plastic surgery and otolaryngology. He has been appointed to numerous high ranking directorships, and clinical and academic positions in his field , and is the current director of his practice.