Overview
Stapes surgery (also called stapedotomy or stapedectomy) is performed to correct hearing loss resulting from bony overgrowth in the middle ear (otosclerosis). There are three connected bones in the middle ear that conduct sound vibrations. When the innermost bone, the stapes, is affected by otosclerosis, it loses its conducting ability and the patient loses hearing. Stapes surgery replaces part of the damaged stapes bone with a prosthesis.
Procedural Details
The surgery can be performed under local or general anesthesia on an outpatient basis. The surgeon accesses the middle ear through the ear canal, so an external incision is often not required.
- Using an operating microscope, the surgeon makes an incision in the ear canal and carefully lifts the eardrum.
- He then removes the portion of the stapes next to the other middle-ear bones and, using either a drill or laser, creates a small hole in the part of the stapes next to the inner ear.
- He places one end of a prosthetic “piston”—a tiny metal or plastic cylinder—in this hole, and attaches the other end to the nearest middle-ear bone. The prosthetic piston acts as a moveable link between the remaining middle-ear bones and the inner ear. (Sound waves vibrate the eardrum, which in turn moves the middle ear bones and piston.)
- The eardrum is then returned to its normal position and held in place with some packing material during the healing process.
If the surgeon opens the ear canal and discovers that the stapes does move (is not otosclerotic), he can usually correct the patient’s hearing loss with a different kind of prosthesis.
Stapes surgery generally lasts 1.5 to 2.5 hours. The patient’s hearing may come and go during the first four weeks after surgery, and he may temporarily hear cracking or popping. During this time, the patient must avoid 1) getting the ear canal wet (to prevent infection) and 2) flying on an airplane (to prevent air-pressure damage). Most patients can return to work within one week of surgery. The degree of hearing improvement is usually apparent within the first month.
Medications
The patient receives anesthetic during surgery and oral medications for post-operative pain, which is usually minimal. Medication for dizziness may be helpful for the first several days following surgery.
Considerations
Patients should consider all options when diagnosed with otosclerosis. For some, the hearing loss is not severe enough to warrant surgery; in these cases, a hearing aid may provide enough improvement. Even patients with severe hearing loss may choose to avoid surgery and use hearing aids. In general, stapes surgery is only recommended when it can eliminate or significantly reduce a patient’s reliance on a hearing aid. The procedure is usually not recommended for patients with preexisting balance problems.
Effectiveness
Stapes surgery improves hearing over 90 percent of the time.
Risks
Risks involved
One in a hundred surgeries will actually make hearing worse. Rarely, the patient will completely lose hearing in the operated ear. This can occur unexpectedly within several weeks of the surgery. In some patients, one’s sense of taste may be altered for several months after the surgery. Patients may have worsening of their balance following surgery, but this is rarely permanent. Severe dizziness or vertigo is not expected after the immediate postoperative period. As with any surgery, there are also the small but finite risks of surgical infection and anesthesia complications.
Risks if not having this Treatments
Hearing loss may worsen.
Urgency
Stapes surgery is an elective procedure and can be scheduled at a patient’s convenience. If there is otosclerosis in both ears, the patient should wait 6 to 12 months before undergoing surgery on the second ear.