INSIDE DR. PETRUSO, PART II: Stapedectomy (12/27/05)

In late December 2005, I at long last paid the price of a youth misspent standing too close to the banks of gigantic speakers at the Fillmore East. My hearing got progressively worse over the years; when it got so diminished that I sometimes missed the ring of students' cell phones in my classes (thus denying me the satisfaction of giving the called parties Holy Ned and throwing them out of the classroom with great flourish), I reluctantly decided that the time had come to take action. An exam by my grad student Marylyn Koble, who is a professional audiologist by day, led to a consultation with Dr. Brian Peters at Medical City in Dallas, who had come highly recommended and was described to me by several people as a surgeon's surgeon. Dr. Peters predicted that a pair of stapedectomies—removal of the stapes bones (better known to you laypersons as "stirrups"), one ear at a time—could well bring my hearing back to normal levels. The possible downside: whenever a surgeon pokes around in your inner ear, there is a risk of damage to your balance, not to mention that you might lose your hearing altogether. I weighed the alternative, which was to go inexorably deaf, and, being an adventurous, throw-caution-to-the-winds kind of guy, I decided to go under the knife.

On the appointed afternoon of the surgery, having obediently but inexplicably avoided all food and drink (even water) since midnight the night before, with stomach growling, I checked into the outpatient surgery department of Medical City. A nurse verified which ear would be the target of the surgery, and with a black magic marker wrote YES under my left ear. The current Mrs. Petruso was obliged to confirm this by writing a big YES under the nurse's YES. What an odd sensation, I thought, for people to write on the side of your neck. Mind you, I assumed they were writing YES, just because the nurse said so, but they could easily have been writing other, more mischievous words (I discovered that the nerve endings in my neck are not arrayed precisely enough to allow me to feel what words were being written). Anyway, I was soon hooked up to an IV drip and wheeled into the OR. A gaggle of medical professionals attended to me for the next three-quarters of an hour.

Dr. Peters, all bunnied up, was at the controls of a large and complex torture-device-looking apparatus, preparing to probe into my head. As soon as I saw the apparatus, I panicked and immediately had second thoughts. I asked Dr. Peters whether he had ever performed a stapedectomy before. In a response that he intended to be reassuring, he said enthusiastically, "Sure! You'll be my second patient!" The Gene Wilder Young Frankenstein gleam in his eye was deeply unsettling; I tried mightily to step off the gurney, but at just that moment the anesthetic kicked in through the IV, and I went limp. The last thing I remember is Dr. Peters saying "Hit it, Igor!!", and a male nurse threw a gigantic knife switch on the wall. This generated a large bluish-white lightning bolt above an ammeter, which immediately spiked. As the air crackled and the aroma of ozone filled my nostrils, my body felt leaden, and I drifted off to a peculiar level of consciousness where I was sorta aware of what was going on around me but could't move.

Anyway, here are the gruesomely fascinating photos of my inner ear, taken by a tiny camera at the end of a tube, like the one Dr. Stiefel used in my gall bladder laparoscopy (see Inside Dr. Petruso, Part I).

This is a close-up of the tympanic membrane at the end of my ear canal. It protects the delicate bones of the inner ear. It needs to be pierced.

 

Here is a gross-out shot of the bones of my inner ear after the tympanic membrane has been sliced into. That angular thingy in the center is my sclerotic and malfunctioning stirrup, which is no longer transmitting vibrations properly to the little pool of liquid where the nerve endings are that transmit audio signals to my brain.

 

In this photo, Dr. Peters has lasered off the stirrup, leaving a vaguely obscene-looking stub.

 

OK, this is the money shot, where Dr. Peters earns his fee. Here we see that he has installed a tiny (one-eighth inch long) stainless steel prosthesis on the stub where my stirrup used to be. The prosthesis is in actuality a little piston, which moves in response to sound waves. Pretty neat, huh?

I forgot to ask him what the displacement of the piston is, and whether I might need a ring job or something after a hundred thousand miles.

 

After installing the prosthesis, Dr. Peters backed the machine out of my head slightly and grafted in some tissue he had taken from my left wrist. Here it is. As for why it's gray I have no idea.

When I woke up, I was in the ward where they put you after they cut on you. The current Mrs. Petruso was sitting at my side reading an issue of People magazine—much to my embarrassment—and looking rather bored with the whole affair. Dr. Peters appeared soon after, congratulated me for being such a great patient, gave me my stirrup in a little vial of alcohol as a souvenir, and hurried off, no doubt to file for the cost of the operation with my insurance provider (I'm guessing he has majorly mortgage payments to make on an A-frame in Aspen or something). After a while, a nurse made me eat some green Jell-O and walk around a little. When she was confident that I was able to keep the "food" down and was well enough to walk without tipping over, she whisked me out to the curb in a wheelchair, I suppose so she could give my bed to another patient as soon as possible. On the ride home the current Mrs. Petruso brought me up to date about Tom Cruise and Britney Spears and other celebs whose names I didn't recognize whom she had read about in the magazine. Her incessant jabbering made me slightly nauseous, but mostly I felt a bit goofy and very mellow. Just as she was pulling into the garage, though, I barfed up the green Jell-O. The current Mrs. Petruso remarked in her sensitive way how lucky I was to have been given a barf bag before I got into her car. I staggered into the bedroom to get horizontal, while the current Mrs. Petruso, uncertain what to do with the barf, ultimately decided to drive to Tom Thumb and drop it into a trash can there.

After a couple of days of spontaneous bleeding from my left ear and minor disorientation, I felt almost as good as new, and my hearing continued to improve over the next two months. It has now tested normal in that ear, and might well be more acute than it was when I was in my twenties (cell phone-addicted students take note). I decided to donate my cute little stirrup (smallest bone in the human body, and all that) to my esteemed colleague Prof. Shelley Smith, who honchos the physical anthropology lab at UT Arlington, with the intention of taking a big fat tax deduction (but only after I had determined that selling body parts on eBay is illegal). All in all, I would recommend a stapedectomy to anyone (in fact, one year later Dr. Peters did my right ear, again with amazing results). These procedures were even more fun than my colonoscopy, which will be the subject of Inside Dr. Petruso, Part III. Stay tuned.

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