In order to surgically restore hearing in
a patient suffering from otosclerosis, the procedure begins by injecting an anesthetic into the ear canal skin. The overall strategy is to reach the stapes
middle ear bone by first lifting the ear canal skin and eardrum away in order to expose the middle ear space. Please note, in reality, the skin is lifted in the top back part of
ear canal rather than the bottom as shown in this animation. The ear canal skin is first incised before
being lifted off the bone carefully. Here the eardrum is now being lifted exposing the middle ear space. Here we can now glimpse the incus and stapes for the first time as the eardrum is moved over to the side. In order to visualize the stapes better, bone is removed using a curette. Care is taken to preserve the chorda tympani nerve just underneath which supplies the sense of taste to the tongue. The incus is than disconnected from the stapes. A laser is than used to remove the stapes
superstructure while preserving the stapes footplate. The laser is again used to drill a hole in
the stapes footplate. A template sizer is than used to determine the correct size implant to place into the hole in the footplate. The implant is than placed into the hole and attached to the incus. Here the implant wire is crimped to secure it to the incus bone. The eardrum and ear canal skin is draped back into normal position. Xeroform packing is placed in the ear canal to help everything heal back to normal.