#439 - Stapedectomy with Fascia Graft

fied and preserved, and the ossicles are observed. The stapes is then separated from the incus using a SI joint knife. A wet towel is introduced to the sterile field for safety and the sur- gical technologist loads the laser fiber and drapes the laser in a sterile fashion. The circulator places eye protection onto the scrub nurse and makes sure everyone dons their own laser glasses before the laser is activated. The laser is set to the recommended settings and is used to cut the stapedial tendon. The laser is then used to cut the arch of the stapes bone. The rest of the stapes suprastructure is removed using the laser and various picks may be used to help remove other remnants of bone. A measurement of the length from the underside of the incus to the hole made in the footplate is made for the prosthesis using a measuring rod. An implant of the surgeon’s choosing is attached to the incus bone and secured using the laser to crimp it around the incus bone. Once the implant is crimped, the temporalis fascia graft is ready to be placed. The surgeon will trim the graft to fit the opening and the area surrounding the prosthesis using a Rosen curved pick and straight pick for placement. The sur- gical technologist will either pass absorbable gelatin powder of various sizes soaked in ofloxacin on a pick to the surgeon, or the surgical technologist may be asked to drop it into the speculum so the surgeon may place it appropriately around the wound. The tympanomeatal flap is then placed back into position and more absorbable gelation powder is used.Wicks soaked in saline may be placed for any drainage and bacitracin may also be injected into the ear. Finally, a cotton ball covered in bacitracin is placed into the ear and a dressing is applied and then fastened around the head. R E C O V E R Y Postoperatively patients should not drive for at least one week to avoid inflammation and possible displacement of the implant. The patient will receive antibiotic drops for the following week, and the packing and suture is usually removed from the ear after seven additional days. Patients also should not lift heavy objects, ride in an airplane, blow their nose, or swim for three weeks. Extreme care should be taken not to get the ear wet because moisture at the site may lead to an inner ear infection and cause hearing loss. The patient should avoid loud noises due to increased audi- tory sensitivity following the procedure. An audiogram is usually performed between one and four months after the | The Surgical Technologist | JULY 2020 308