What is a Stapedectomy?
A stapedectomy is middle ear surgery to treat otosclerosis. This procedure improves sound transmission when otosclerosis fixes the stapes bone in place.
The stapes bone is the smallest bone in the human body and one of several middle ear bones that transmit sound waves. The annular ligament holds the stapes footplate, which passes sound vibrations into the inner ear fluid. In otosclerosis, abnormal bone growth stiffens the stapes bone and footplate. Sound then cannot travel through the middle ear properly, causing conductive hearing loss.
During stapes surgery, the surgeon bypasses the fixed stapes footplate with a tiny, piston-like stapes prosthesis that carries sound from the incus bone into the inner ear. Two related procedures are used:
- Stapedotomy: The surgeon removes the upper part of the stapes bone and creates a small hole, called a fenestra, in the stapes footplate. The prosthesis sits in this opening. Small-fenestra stapedotomy is now generally preferred because it preserves most of the footplate, tends to preserve high-frequency hearing well and may cause less inner ear disturbance.
- Stapedectomy: The surgeon removes a larger part, or almost all, of the stapes footplate and seals the opening with a tissue graft before placing the prosthesis. This may be needed if a small fenestra cannot be created safely or if the stapes bone becomes mobile or fragments during surgery.
The term stapedectomy surgery is still commonly used to describe both procedures. The intended operation may therefore be described as a stapedotomy with a stapedectomy if the anatomy or surgical findings require it.
Why is a Stapedectomy Done?
Stapedectomy surgery treats conductive hearing loss caused by otosclerosis when the expected benefit outweighs the risks.
Consider this middle ear surgical procedure if gradual hearing loss affects your conversations, work, safety, or quality of life. Some people also have tinnitus that a stapedectomy can help. Improving sound conduction may reduce the tinnitus for some patients, but this cannot be promised, and the tinnitus may persist or worsen.
Not everyone with otosclerosis needs surgery. Other options may include:
- observation with repeat hearing tests when hearing loss is mild
- a hearing aid when amplification provides useful hearing, or when surgery is not preferred
- stapes surgery when the diagnosis is secure, inner ear function and cochlear reserve are good, and the patient understands the benefits, limitations and risks
An audiogram usually shows an air-bone gap, meaning the ear hears better through bone conduction than through the usual air-conduction pathway. A conductive loss of about 25 decibels or more can support surgical candidacy. A negative Rinne test with a 512 Hz tuning fork may also support the diagnosis. These findings do not decide treatment on their own, as speech testing, the ear with poorer hearing, symptoms, anatomy, general health, work and personal preferences all matter.
A stapedectomy does not generally treat age-related or noise-induced sensorineural hearing loss. It also cannot restore the inner-ear component of mixed hearing loss. A hearing aid may still be needed if the cochlear reserve is limited.
A stapedectomy may also be unsuitable for a person who is not medically fit for anaesthesia, has persistent balance disease, has an ear anatomy that makes surgery unsafe, or has only one functioning hearing ear.
If both ears are affected, doctors usually consider the poorer hearing ear first. Discuss surgery on the second ear only after the first ear has healed, and doctors have assessed the results.
When to See an ENT Specialist
See an ENT specialist if your hearing loss is gradual, one-sided or affects your daily life, or if it occurs with tinnitus, ear pressure or balance symptoms.
Otosclerosis often progresses slowly, so the change may first appear as difficulty hearing low-pitched sounds, quiet voices or conversation. An ENT assessment is also important because earwax, middle ear fluid, a middle ear infection, a perforated eardrum and other bone problems can produce a similar conductive pattern.
Sudden hearing loss is a different problem. Seek urgent medical assessment if hearing drops over hours or a few days, particularly in one ear. It may be a sudden sensorineural hearing loss, which needs a prompt medical evaluation rather than a stapedectomy.
How to Prepare for a Stapedectomy
Preparing for stapedectomy surgery involves confirming the diagnosis, assessing surgical fitness and planning a safe recovery at home.
The preoperative assessment commonly includes:
- A physical examination of both ear canals, the middle ear and the eardrums
- Hearing tests, including pure-tone audiometry, speech testing, tympanometry and acoustic reflex testing by an audiologist
- Tuning fork tests to compare air and bone conduction
- A high-resolution CT scan of the middle ear and temporal bones in selected cases, especially if the hearing pattern is unusual or another structural cause, such as an enlarged vestibular aqueduct, must be excluded
- Review of medical conditions, previous ear surgery and any dizziness, tinnitus or ear infections
Tell your healthcare provider and surgical team about all your medicines, supplements and allergies. Do not stop your prescribed medicines unless your surgeon or prescribing doctor tells you to.
Follow the hospital’s fasting instructions if local or general anaesthesia is planned. If you smoke or vape, stopping before surgery can support healing and reduce anaesthetic and chest risks. Report a cold, fever, ear pain or ear discharge before the operation.
Arrange for an adult to take you home and stay with you for the first night. Plan time away from work, avoid booking air travel soon after surgery and prepare to keep the ear dry. If a vein graft is planned, the surgeon explains where it will be taken.
What Happens during a Stapedectomy?
During stapedectomy surgery, the surgeon reaches the middle ear through the ear canal, confirms the stapes fixation and places a prosthesis to bypass the stapes bone.
The operation can use local anaesthesia or general anaesthesia. If the team uses general anaesthesia, they may monitor the facial nerve. Whether you have local anaesthesia or general anaesthesia depends on your health and the surgical team. The procedure often takes about 60 to 90 minutes, although difficult anatomy or an unexpected finding can make it longer. It is usually planned as day surgery or a short hospital stay.
The usual steps are:
- The surgeon views the ear through a microscope or endoscope and gently lifts part of the tympanic membrane, or eardrum, to enter the middle ear.
- The surgeon examines the middle ear bones and confirms the stapes fixation. The surgeon identifies the facial nerve and its nearby tympanic segment. If the findings do not support a safe stapes surgery, the surgeon may stop the operation.
- The surgeon separates and removes the upper part of the fixed stapes bone, called the stapes superstructure.
- In a laser stapedotomy, the laser makes a small hole in the stapes footplate. A microdrill may be used instead. If bone fragments prevent a safe opening, a partial or total stapedectomy may remove more of the footplate.
- A stapes prosthesis is attached to the incus and placed in the opening or onto a tissue graft over the oval window. This reconstructs the sound pathway.
- The tympanic membrane is returned to position, and absorbable material or an ear pack may be placed in the canal.
The approach is usually through the ear canal, so there is no visible skin incision. A small cut in front of or behind the ear may occasionally be needed for access or to collect fascia, a vein graft or other tissue at a separate surgical site. The surgeon may examine unexpected tissue if needed.
Endoscopic ear surgery may provide a wide view through the ear canal in suitable cases. The final approach depends on the anatomy and the surgeon’s judgement.
What to Expect After Surgery and the Recovery Timeline
After a stapedectomy, most patients go home the same day or after a short observation period, then recover gradually over several weeks as swelling settles and the ear heals.
Immediately after surgery, hearing may seem blocked or muffled because of packing, fluid and swelling. Mild pain, a small amount of blood-stained discharge, popping sounds, nausea, tinnitus, taste disturbance or unsteadiness can occur. Pain is usually controlled with prescribed or simple oral pain relief. Start with fluids and light food if nausea is present. Do not put drops or objects into the ear unless instructed.
Stapedectomy recovery varies, but a typical course is:
- First two days: Rest, keep the head raised and walk carefully. Mild dizziness is common. Have someone nearby and do not drive.
- First one to two weeks: Keep the ear dry. Do not blow your nose. Sneeze with your mouth open, and avoid straining, heavy lifting and vigorous exercise. You may return to school or desk-based work within one to two weeks if dizziness has settled. Physical work may require a longer rest.
- Two to four weeks after surgery: At a follow-up appointment, the surgeon checks the healing and removes or reviews any ear pack, depending on the material used. Continue water and activity precautions until your doctor clears you.
- Four to twelve weeks after surgery: Hearing becomes clearer as the ear settles. A follow-up audiogram measures hearing improvement. Hearing can fluctuate and may take up to about three months to stabilise.
Do not swim, dive or fly until the surgeon says the ear has healed. This is often several weeks, but the timing may vary. Avoid contact sports, loud sounds, and pressure changes until cleared.
Stapes surgery aims to improve hearing, but results vary. Some patients no longer need a hearing aid in the operated ear, while others use one to further improve their hearing. The operation does not stop all otosclerosis from progressing and does not correct unrelated inner ear hearing loss.
A prosthesis is intended to remain in place for the long term. Hearing can decline later because otosclerosis progresses, inner ear hearing changes with age or noise exposure, scar tissue forms, or the prosthesis shifts. Revision surgery may be considered, but its outcome is generally less predictable than the first operation.
Risks and Possible Complications of a Stapedectomy
The main stapedectomy risks involve hearing, balance, taste, the tympanic membrane, the prosthesis and nearby nerves.
Potential complications include:
- temporary dizziness or vertigo, sometimes lasting days or weeks
- taste disturbances, a metallic taste or numbness on one side of the tongue from irritation of the chorda tympani nerve, which often improves over time
- tinnitus that persists, starts or becomes louder
- hearing that does not improve, improves only partly or later declines
- sensorineural hearing loss, including rare severe or irreversible hearing loss in the operated ear, sometimes called a dead ear
- tympanic membrane perforations, infections, bleeding or a reaction to the ear packing
- movement or loosening of the prosthesis, which may cause recurrent conductive hearing loss
- a perilymphatic fistula, or inner ear fluid leak, which can cause persistent dizziness or fluctuating hearing
- reparative granuloma or scar tissue around the prosthesis
- a facial nerve injury, which may cause facial weakness or facial paralysis and requires urgent assessment
- anaesthetic complications
A stapedotomy is often preferred because its surgical technique removes less of the footplate and may have a lower risk of inner ear injury than a larger stapedectomy. Even so, the technique alone does not determine safety. Permanent facial paralysis from a facial nerve injury is very rare. Careful patient selection, accurate prosthesis placement and experience in middle ear surgery are important.
Seek urgent medical advice after surgery for sudden or rapidly worsening hearing, severe or persistent vertigo, repeated vomiting, increasing pain, fever, foul-smelling discharge, continuous bleeding, new facial weakness or swelling around the ear.
How Barrie Tan ENT Head & Neck Surgery Can Help
Barrie Tan ENT Head & Neck Surgery can confirm whether otosclerosis is causing your hearing loss, explain non-surgical and surgical options, and support you through recovery. If you would like to learn more about how a stapedectomy can help, or stapedectomy costs, Dr Tan can assist you.
For patients considering stapedectomy in Singapore, the assessment is individual. Dr Tan will review the audiogram and ear findings, arrange further audiological testing or CT imaging when needed, and discuss observation, hearing aids and surgical management without assuming that surgery is the right choice. For stapes surgery, he will explain the intended technique, the possibility of conversion from a stapedotomy to a stapedectomy, whether the procedure is likely to improve your hearing, the expected limits of hearing improvement, and the risks involving the inner ear or facial nerve.
If gradual hearing loss or otosclerosis is affecting your everyday communication, contact Barrie Tan ENT Head & Neck Surgery to arrange a consultation at Gleneagles Hospital and discuss your next steps.
FAQs about a Stapedectomy
How many years does a stapedectomy last?
A stapedectomy is intended to provide long-term hearing improvement, and a well-positioned prosthesis can continue to work for many years or decades. It has no fixed expiry date.
What to expect after a stapedectomy?
Expect temporary muffled hearing, ear fullness and mild dizziness while packing and swelling settle. Keep the ear dry, avoid nose blowing, heavy lifting, vigorous exercise, swimming and flying until cleared. Hearing usually becomes clearer over several weeks and is checked with an audiogram after healing.
How painful is a stapedectomy?
A stapedectomy usually causes a mild pain or moderate ear discomfort, not severe pain. Oral pain medication is often enough to treat discomfort. Seek prompt medical advice for severe pain, worsening pain, or pain with fever, swelling, or foul discharge.
What are the long-term side effects of a stapedectomy?
Most early side effects improve, but possible long-term problems include persistent taste disturbance, tinnitus, imbalance, residual or recurrent hearing loss, prosthesis displacement and, rarely, permanent sensorineural hearing loss, facial weakness or facial paralysis. Revision surgery may be an option for some mechanical problems.
Is a stapedectomy worth it?
A stapedectomy can be worthwhile when a confirmed otosclerosis causes a meaningful conductive hearing loss, the cochlear reserve is good, and the patient prefers surgery after comparing it with a hearing aid. The decision is personal because improvement is not guaranteed and a small risk of worse hearing remains.
