Stapedectomy is a microsurgical procedure designed to correct conductive hearing loss caused by otosclerosis, a condition in which abnormal bone growth immobilizes the stapes bone in the middle ear.
What is stapedectomy surgery?
Stapedectomy is a microsurgical procedure performed to treat conductive hearing loss caused by otosclerosis, an abnormal bone remodeling process in the middle ear that fixes the stapes bone and prevents it from vibrating. During stapedectomy, the surgeon uses an operating microscope to gain access to the middle ear, removes or immobilizes the diseased stapes footplate, and then places a prosthesis made of Teflon or titanium to bridge the gap between the incus and the inner ear’s oval window. This prosthetic replacement restores the mechanical transmission of sound waves into the cochlea, significantly improving hearing thresholds and speech discrimination. The procedure is typically carried out under local or general anesthesia and lasts approximately 45 minutes to an hour. Candidates for stapedectomy are patients with progressive conductive hearing loss, an air–bone gap of at least 20 decibels on audiometry, and cochlear reserve, often after management or unsuccessful hearing aid use. Modern surgical refinements, including footplate fenestration and stapes piston techniques, have reduced trauma, minimized perilymph leakage, and enhanced postoperative outcomes. While risks such as taste disturbance, dizziness, or rarely sensorineural hearing loss may occur, most patients experience rapid recovery and substantial hearing improvement, leading to an enhancement in quality of life.
Why would I need a stapedectomy?
Stapedectomy is recommended for patients who experience conductive hearing loss caused by otosclerosis, a condition in which abnormal bone growth in the otic capsule fixes the stapes footplate and impairs its ability to transmit sound vibrations into the inner ear. Patients who have an air–bone gap of 20 decibels or more on audiometric testing, despite trials of hearing aids, derive the greatest benefit from surgical intervention. A stapedectomy is considered when patients notice progressive difficulty understanding speech in quiet or noisy environments, if wearing a hearing aid fails to sufficiently restore clarity, or if they experience social or occupational limitations due to hearing impairment. Tinnitus correlating with stapedial fixation and a stable cochlear reserve confirming healthy inner ear function are other considerations. Candidates must undergo thorough evaluation, including tympanometry, acoustic reflex testing, and high-resolution computed tomography to rule out other middle ear pathologies and confirm otosclerotic foci. While alternatives such as amplification devices may alleviate symptoms, stapedectomy offers a definitive approach by replacing or bypassing the immobilized stapes with a prosthesis, achieving near-normal hearing thresholds. If your audiologist and otologist determine that medical management and hearing aids no longer suffice, a stapedectomy may restore communication abilities and quality of life.
What to expect during a stapedectomy?
During a stapedectomy, you arrive at a surgical center, undergo preoperative checks, and receive either local sedation or general anesthesia. The surgeon uses an operating microscope to access the middle ear through the ear canal, makes a tiny incision to lift the eardrum, and exposes the ossicles. The fixed stapes bone is removed or mobilized, and a small opening in the oval window is created with a laser or drill. A prosthetic piston made of Teflon or titanium is then placed to bridge the incus to the inner ear, restoring sound transmission. The eardrum is repositioned, and absorbable packing may support healing. The full procedure typically takes 45 to 60 minutes.
Stapedectomy recovery & long-term care
Recovery from a stapedectomy unfolds in distinct phases, beginning with the immediate postoperative period and extending into long-term care to safeguard hearing gains. In the first 24 to 48 hours, patients commonly experience mild dizziness, ear fullness, and minimal bleeding; head elevation, ice packs, and prescribed analgesics help control discomfort. It’s essential to keep the ear dry—avoid shower water entry, swimming, nose blowing, or heavy lifting for two to three weeks—and to sleep with the head turned away from the operated side. Absorbable ear canal packing usually dissolves or is removed at the one-week follow-up, when your surgeon inspects the eardrum and ensures there’s no infection or prosthesis displacement. Hearing improvements often become noticeable within days, but formal audiometry is scheduled at four to six weeks to document air-bone gap closure and prosthesis function. Long-term care focuses on protecting the inner ear: treat upper respiratory infections promptly, avoid environments with sudden pressure changes (scuba diving or unpressurized flying), and wear hearing protection in noisy settings. Annual or biennial hearing tests help detect any late prosthesis extrusion, perilymph fistula, or sensorineural decline.
Conclusion
Stapedectomy stands as a definitive solution for conductive hearing loss caused by otosclerosis, offering the potential to close the air–bone gap and restore near-normal sound transmission. Success hinges on meticulous patient selection, precise microsurgical technique—often aided by lasers and high-powered microscopy—and comprehensive preoperative assessment to confirm adequate cochlear reserve. Although risks such as transient dizziness, taste disturbance, or rare sensorineural hearing loss warrant thorough counseling, modern prosthesis materials and finesse in footplate fenestration have markedly improved safety and outcomes. Equally important is the postoperative regimen: activity restrictions, ear-care precautions, and scheduled audiometric evaluations safeguard prosthesis stability and detect complications early. When a patient commits to this continuum—from evaluation through long-term follow-up—a stapedectomy can dramatically enhance speech clarity, reduce reliance on amplification devices, and elevate quality of life.
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