Why is stapedectomy carried out?

Stapedectomy (or to use the more accurate term, stapedotomy), is an operation designed to improve hearing in patients with otosclerosis. This is a condition in which new bone forms around the third small bone of hearing (stapes), stopping it moving properly and causing a partial loss of hearing.

Are there any alternatives to surgery?

Patients with otosclerosis will almost always be offered a hearing aid as an alternative to surgery, and will be encouraged to try one before making a final decision regarding surgery.

How is the surgery performed?

The operation is carried out under general anaesthetic (you are completely asleep).

It is extremely delicate and intricate surgery, carried out using an operating microscope and a specially designed laser, and usually takes between 1 1/2 and 2 hours.

We use a small scar in the root of the ear just above the ear canal to improve our access and to take some graft material used during the procedure.

We then lift up the ear drum, remove a very small amount of bone from the ear canal to be able to see the stapes, and remove the top part of the stapes using the laser.

We then create a very small hole in the "footplate"of the stapes with the laser (the diameter of the hole is usually 0.8mm) and insert an artificial replacement stapes (prosthesis)

The ear drum is held back down with a small dressing or "pack" in the ear canal and the scar is closed with dissolving stitches buried under the skin.

What can I expect after the surgery?

You will probably have a bandage around your head when you wake up. This is to reduce the risk of bleeding or extensive bruising.

The bandage will be removed before you go home. You will need to stay in hospital overnight following the surgery and should be able to go home the next morning.

You may feel quite dizzy when you wake up, but this should wear off quickly, and you will not be discharged home until the dizziness has settled.

You will be given some pain relief to take home.

Because the sutures are dissolving and buried under the skin you will not need to have any sutures removed.

While the pack is in place, the hearing in that ear will be reduced. The pack will be removed at your out-patients appointment 2 weeks after the operation. You will normally be given a one week course of antibiotic ear drops to use after the pack has been removed.

The pack is important because it holds the ear drum back in place and stops the ear canal from narrowing down as a result of scarring. If the pack falls out within the first 10 days after the operation it is important that you get in contact, either via the ward or the appropriate secretary, as it may need replacing. The pack looks like a short piece of crumpled ribbon and may be yellow or brown.

You may get small amounts of discharge or bleeding from the ear during the healing process, and this is generally nothing to worry about. However if there is a lot of discharge or if it starts to smell offensive you may have an infection and should either consult your GP or get back in contact directly.

Similarly if the wound or external ear start to look red you should seek medical advice.

You should plan to take 2 weeks off work following the operation. Children should generally plan to take 2 weeks off school. There is some flexibility in this. If you have a sedentary job or can work from home you may be able to return to work sooner if you wish, but if you have a physically demanding job you may need a little longer. We will, of course, be happy to discuss this with you.

You will need to continue to keep water out of your ear for at least 6 weeks following the surgery.

You should avoid flying for at least 6 weeks after the operation.

What are the risks of the surgery?

All operations, however carefully and expertly they are carried out, have risks attached.

Almost all operations carry a small risk of infection, bleeding or extensive bruising or that the scar will be prominent or heal poorly.

About 85% of patients will notice a significant improvement in their hearing following surgery. This does not necessarily mean that the hearing in that ear will be completely normal, but it should be noticeably better.

About 10-15% of patients may find that  their hearing is no better or a bit worse. This may be for one of a number of reasons.

It may be that in fact otosclerosis was not the problem, and that the hearing loss was actually being caused by a condition that is not treatable with surgery. This is fortunately quite rare.

It is possible that at some stage during the operation we feel that the risks of proceeding are too great, and we abandon the operation. This does happen occasionally, particularly if we feel that the nerve that controls the muscles of the face (facial nerve), which can sometimes lie in an abnormal position within the middle ear, is at significant risk.

It is also possible that despite the operation having been carried out with the utmost care, the hearing either doesn't get better or looks better on a hearing test but doesn't feel noticeably better to the patient.

In any of these situations a hearing aid would still be very likely to be useful.

There is also a very small but well documented risk, in the region of 2%, of complete loss of hearing in the operated ear. If this does occur it is very likely to be permanent, and would not be treatable with a normal hearing aid. A BAHA, however, may sometimes be an option (please see BAHA page).

There is also a small chance that the operation may be successful initially but that the hearing may worsen again after a number of months or years. There is even a tiny chance of complete hearing loss that may occur some years after the surgery, particularly if patients are subjected to a sudden change in pressure.

In any situation where the hearing deteriorates following surgery the hearing in the other ear will not be affected.

Hearing and balance are very closely related. You may feel quite dizzy when you wake up, but this should wear off quickly, and you will not be discharged home until the dizziness has settled. You may then feel a little unsteady for a few days, but again this should wear off. There is, however a small chance of more prolonged balance disturbance. As with hearing deterioration, this can occasionally happen some months or years after the surgery. In the 2% of patients who experience complete loss of hearing in the operated ear, it is likely that they would also lose all balance function in that ear. This may lead to a prolonged balance problem that could take several months to recover from completely.

Some patients with otosclerosis already have noises in the ears (tinnitus). There is a chance that the tinnitus may worsen following the surgery, but this is usually temporary. There is also a small chance of developing tinnitus after the operation, but again this usually settles down with time.

When we lift up the ear drum, there is a very small risk of causing a hole (perforation) in the ear drum. If this were to happen we would normally repair it there and then, but there would be a small risk of requiring further surgery if this perforation didn't not heal.

The nerve that supplies taste to the tongue on that side runs through the ear drum on its way to the tongue. When we lift up the ear drum this nerve occasionally gets stretched or damaged. If this happens you may notice either a loss of taste down that side of the tongue or an odd, metallic taste. If this does happen it is almost always temporary, but may take several months to settle down completely.

The nerve that moves the muscles on that side of the face runs through the middle ear very close to the stapes. There is a tiny risk of this nerve being damaged during the surgery, which could lead to symptoms ranging from a mild, temporary weakness of part of the face to a permanent paralysis of one side of the face. This is fortunately very rare, and, as mentioned above, if we feel that the nerve is at significant risk because it is in an abnormal position, we tend to consider abandoning the operation.


ear diagram labelled with lines