Stapedectomy Revisited

A little less than three years ago—on May 25, 2005 to be precise—I wore a hearing aid in my left ear for the last time.

That moment came thirteen years after the word ‘otosclerosis’ ushered me in, none too gently, to the world of hearing impairment—where audiograms signed with Xs and Os have nothing to do with notes of endearment but mark left- and right- side decible levels on graph after graph, charting peaks and valleys far below the 20dB ‘normal adult threshold’ for hearing.

What I learned in those thirteen years, both about otosclerosis and about myself, could fill a book: cliché aside, it has. And now I am about to be able to complete that book, a collection of non-fiction essays that I began in 2000: now, as I am about to submit my right ear to the same procedure I had on my left in 2005, I can’t help but think about the relationship between the body and the self, the physical and the ethereal, the allegory that is written by our bodies and edited by our consciousness. Too heavy? Well, I guess I’m feeling a little heavy. Funny, but I am more nervous this time around than I was the last. More on that in a moment. For now, a little about otosclerosis, the reason for my hearing loss.

Otosclerosis is a congenital condition affecting the bones of the middle ear (incus, malleus, and stapes) that causes degenerative hearing loss; it is caused by an abnormal growth of spongy bone that prevents the bones from vibrating correctly and carrying sound waves to the inner ear. Surgically, the condition is treatable through a procedure called a stapedectomy: the removal of the stapes, via laser, and its replacement with a small titanium rod. The procedure eliminates the spongy bone and allows for proper movement and conductivity in the middle ear.

The stapedectomy yielded very good, though not perfect, results for me in 2005: though my hearing on that side does not quite break the normal threshold, I have noticed a marked improvement over my preoperative hearing, and I have not, after all, even seen my old hearing aid since I handed it off to my husband just before the surgery.

So why am I more nervous this time? This should be comfortable territory as there are far fewer ‘unknowns’ this time around, having been here before. But that’s just it: last time, the condition of my middle ear came as a surprise to my otolaryngologist—he’d not seen such significant bone growth in someone so young. In addition to the expected spongy bone, a ‘bony shelf’ had formed over all of the bones, making them difficult to access. This explains why my onset was so early in life: I was 16 when I was first diagnosed, while onset for otosclerosis usually doesn’t occur until folks are in their late 20s or early 30s at least. To complicate matters more, I apparently have a malformed incus, a deep ear canal, and a prominent facial nerve (which, for those who are not necessarily anatomy enthusiasts, courses right through the middle ear), making the logistics of working in my middle ear even more challenging. What should have been a laser procedure required a drill. What was already a difficult maneuver became an even greater challenge. And Dr. P– expects to find the same thing when he goes into my ear on Wednesday. But, no—that’ not really what is making me feel a little uncertain.

The fact is that last time I was fully hearing impaired going in to the surgery; I had nothing to lose, really. If the procedure worked, then great; if it didn’t —and there’s always the risk—I still had another functioning, if aided, ear. There was safety in that status quo offered by my right. Though the left is now improved, I know that it is still weak. The potential for having little to no improvement in my right—or losing my hearing in that ear all together—is unsettling. To go through all of this only to be no better off is a discouraging potentiality.

Then, of course, is the potential for facial paralysis; loss of feeling, function, and control; inability to produce or control tear production; loss of muscle control, speech impairment, taste disruption, et al., et al. As a person who makes her living, at least in part, by speaking, this is not an appealing prospect. As a woman who at least tries to look reasonably put together, superficial though such objectives may be, well . . . . And as a person who loves to sing (though what results in not fit for normally-functioning human ears), and smile, and laugh, and chase her children around making a ‘lizard face,’ entertaining the possibility of exchanging hearing impairment for facial impairment nearly makes me want to rethink my ante.

And finally, in what is perhaps the ultimate example of illogical though compelling human impulses, I am worried about being able to hear.

Let me explain: I was very angry when I was first diagnosed with otosclerosis. I refused to wear my hearing aids. Chaos and disappointment ensued. I was obstinate. It was a long, complex battle. Eventually, I healed. I learned. And through it all, quietly and without a particular, discrete, discernable turning point, I adopted a new cultural identity. I belonged to a discrete community. I was ‘hearing impaired.’ The hearing loss became a significant part of my identity; who might I be without having that experience? Who will I be, in Pound’s words, “after the sound” (Canto XIII)?

Absurd though it may seem, my most significant concern is not that the surgery won’t work, but that it will.