What Is Stapedotomy?
The stapes bone is the smallest bone in the human body and one of the three middle ear bones, the ossicles. The eardrum, or tympanic membrane, helps these middle ear structures transfer acoustic energy into cochlear fluid. Otosclerosis causes abnormal bone growth around the stapes footplate. This bone change stiffens the stapes bone, so sound cannot pass efficiently into the inner ear, causing conductive hearing loss.
A stapedotomy is a middle ear surgical procedure used to treat hearing loss caused by otosclerosis. This procedure can improve hearing and sound transmission when the stapes bone becomes fixed.
During the stapedotomy procedure, the surgeon removes the upper part of the fixed stapes bone, makes a precise hole in the footplate of the stapes bone and places a piston-like prosthesis. This connects the middle ear structures to the inner ear. The prosthesis bypasses the fixed stapes bone and transfers acoustic energy through the middle ear.
It is a minimally invasive form of middle ear surgery, usually performed through the external auditory canal without a visible incision.
A stapedotomy and stapedectomy are related but not identical types of surgery. A stapedotomy creates a precise hole in the stapes footplate, while a stapedectomy removes a larger part or all of the footplate of the stapes bone before placing a prosthesis and tissue graft. Many surgeons prefer a stapedotomy because it preserves more of the stapes footplate, is generally less traumatic to the inner ear, and may reduce some complications. The appropriate stapes surgery depends on the anatomy, technique and surgeon experience.
Why Is a Stapedotomy Done and Who May Need Stapedotomy?
Otosclerosis often begins in the teens or early twenties, though symptoms may appear later. A family history increases the likelihood of otosclerosis arising. Hearing loss caused by otosclerosis ranges from mild to severe and can affect one or both ears. Tinnitus may also occur concurrently. Less often, otosclerosis affects inner ear nerve cells and causes sensorineural hearing loss.
A stapedotomy is done to improve conductive hearing loss from a confirmed stapes fixation when the expected benefit outweighs the risks. The stapedotomy procedure can treat conductive hearing loss caused by a fixed stapes bone. Stapedotomy surgery can improve hearing by correcting the conductive component and may improve the quality of life, but it cannot reverse sensorineural hearing loss or stop the disease process.
A stapedotomy is usually avoided with an active ear infection, uncontrolled balance disorder, inadequate inner-ear hearing, or concern about operating on the only hearing ear. The decision is individual and should follow a complete ear and hearing assessment.
Surgery may be appropriate when:
- An audiogram shows a meaningful air-bone gap between hearing levels.
- Hearing loss affects conversation, work, safety or daily activities.
- Inner ear hearing remains good enough for the prosthesis to provide useful benefit.
- You understand the alternatives, the expected results and the small risk of worse hearing.
- You prefer stapedotomy surgery to the continued use of a hearing aid.
Stapedotomy surgery may not be necessary for mild hearing loss, as a regular hearing aid can improve hearing and communication without surgery.
When to See an ENT Specialist
See an ENT specialist if your hearing is gradually worsening, especially if one ear is worse, tinnitus persists, or communication is becoming difficult.
A proper ENT assessment can distinguish otosclerosis from wax, fluid, tympanic membrane disease, damage to the middle ear bones, and other causes of conductive hearing loss. The ENT specialist examines the ear canal and tympanic membrane. An audiologist then uses a hearing test to measure air conduction, bone conduction and speech hearing. Tympanometry and acoustic reflex tests provide information about middle ear function and stapes fixation. A high-resolution CT scan of the temporal bones may be advised when the diagnosis or anatomy is uncertain, but is done only if the results would affect the surgical procedure.
Sudden hearing loss differs from the slow change typical of otosclerosis. Seek urgent medical care if your hearing drops suddenly, particularly if you also suffer severe dizziness, facial weakness, or neurological symptoms.
How to Prepare for a Stapedotomy
Preparing for a stapedotomy involves confirming your suitability, reviewing your health and medicines, and planning for a safe recovery.
Before stapes surgery, the ENT specialist will review your medical history, conduct hearing tests and an ear examination, and order any medical imaging. If both ears are affected, they generally treat the ear with poorer hearing first. Discuss your work, flying, diving, and balance needs for hearing aids after stapes surgery.
Your surgical team may ask you to:
- Provide a full list of prescription medicines, over-the-counter products, supplements and allergies. Blood thinners and some diabetes medicines may need specific instructions. Do not stop prescribed medicines unless your doctor tells you to do so.
- Follow the hospital’s fasting instructions if you are having general anaesthesia or sedation.
- Tell the clinic if you develop a cold, fever, ear discharge, or ear infection before stapes surgery. The procedure may need to be postponed until the infection settles.
- Stop smoking and vaping as early as possible because nicotine and smoke exposure can impair healing and increase anaesthetic risks.
- Arrange for an adult to take you home and stay with you during the first night.
- Plan time away from work and help with lifting, childcare or household tasks.
The stapedotomy procedure may be performed under local or general anaesthesia. The choice depends on your health, preference, the surgeon’s technique and the expected complexity of stapes surgery.
What Happens During a Stapedotomy?
During the stapedotomy procedure, the surgeon will bypass the immobile stapes bone with a small prosthesis, helping sound reach the inner ear.
Surgery often takes about an hour but may take longer in difficult cases. It is usually same-day surgery, but you may need to stay overnight. Most stapes surgery is done through the ear canal, without a visible external incision. You may need a small incision for access or to graft tissue.
The main steps are:
- The surgeon views the tympanic membrane and middle ear through an operative microscope or an ear endoscope. The tympanic membrane is gently lifted to expose the middle ear bones.
- The surgeon checks the movement of the hearing bones in the middle ear to confirm that the stapes bone is fixed.
- Fine instruments separate and remove the upper part of the stapes bone. A laser or microdrill may be used to make a tiny opening in the stapes footplate. Laser stapedotomy is one technique, but it is not essential.
- A piston-like prosthesis is placed through the opening and attached to the incus. Vein, fascia, fat or other tissue may seal the opening.
- The tympanic membrane is returned to its normal position. Soft packing may be placed in the ear canal to support healing.
A stapedotomy will remove a very small amount of bone from the stapes footplate and reconstruct the middle ear sound-conduction pathway. A routine procedure does not usually produce a specimen for laboratory testing. If the surgeon finds unexpected tissue, they may send it for examination when clinically appropriate.
If intraoperative complications or unsafe anatomy occur, such as facial nerve involvement that blocks access, the surgeon may stop the surgery to protect hearing and nerve function. If a precise hole in the stapes footplate cannot be created safely, a stapedectomy may be considered during the same surgery, if agreed upon before the procedure, or after further discussion.
What to Expect After Surgery and the Recovery Timeline
Recovery after stapes surgery usually takes a few weeks, while hearing may take up to three months to settle.
Some symptoms can occur immediately after a stapes surgery. The treated ear often feels blocked because of swelling and packing. Hearing may initially seem unchanged or worse. Mild ear discomfort, a small amount of blood-stained discharge, tinnitus, nausea or slight dizziness can occur. Dizziness may last a few hours and usually improves as the inner ear settles.
Pain at the surgical site is commonly managed with the medicines the surgical team advises. If anaesthesia causes nausea, start with fluids and light food, then return to a normal diet as much as you can tolerate. Do not remove packing or put cotton buds into your ear. Use prescribed ear drops only as directed.
A typical recovery timeline goes as follows:
- First 48 hours: Rest, keep your head raised when lying down and stand up slowly. Gentle walking is reasonable if you feel steady.
- First one to two weeks: Many people can return to desk-based work when the dizziness has settled. Manual work or work involving heights, heavy lifting, or balance may take longer. If an external incision is made, stitches are checked, and any non-dissolving stitches are usually removed during this period.
- First two to three weeks: The ear packing is reviewed and may be removed, depending on the material and the surgeon’s plan. Hearing may improve after the packing comes out, but can still fluctuate.
- First few weeks: Keep the ear dry. Avoid nose blowing, straining, heavy lifting and vigorous exercise. Sneeze with your mouth open. Do not swim, dive or fly until your surgeon confirms that pressure changes are safe.
- About six to twelve weeks: Hearing becomes more stable. A follow-up audiogram is often arranged once healing is sufficient to measure the result accurately.
More than 80% of appropriately selected cases report useful hearing improvement, and many studies report improvement in more than 90%. Some patients can reduce or stop using a hearing aid in the operated ear, but this cannot be guaranteed. A hearing aid may still be needed when there is inner ear hearing loss or disease in the other ear.
High-frequency hearing can vary. High-frequency hearing gain is often smaller than at lower frequencies, and no technique restores every frequency to normal. Otosclerosis can continue to affect the inner ear over time.
Risks and Possible Complications
Stapes surgery can improve hearing, but it carries a small risk of no benefit, worse hearing, and other ear or anaesthetic complications. Complications during the operation can include tympanic membrane perforations, damage to the middle ear bones, an inner ear fluid leak or facial nerve damage. Postoperative complications and other possible risks include:
- Temporary dizziness, imbalance, nausea or vomiting. Though persistent vertigo is uncommon.
- Temporary or lasting change in taste caused by stretching or injury to the chorda tympani nerve.
- Tinnitus that improves, stays the same, or becomes more noticeable.
- No meaningful hearing improvement or recurrent conductive loss if the prosthesis moves, scar tissue or new bone develops, or otosclerosis progresses.
- Sensorineural hearing loss, including a rare risk of severe or complete hearing loss in the operated ear, which can lead to a condition known as a dead ear.
- A tear in the eardrum, infection or bleeding.
- Facial nerve injury, which can cause facial weakness or facial paralysis. However, permanent facial paralysis is extremely rare.
- Sensitivity to packing or ear drops, and the general risks of anaesthesia.
Some postoperative complications, such as a shifted prosthesis, may cause recurrent conductive hearing loss. Revision stapes surgery may be more complex, and results can be less predictable than after first-time surgery.
Most postoperative complications are temporary, but some require prompt care. Contact the surgical team urgently for a sudden marked drop in hearing, severe vertigo, repeated vomiting, facial weakness, increasing pain, fever, heavy bleeding, foul-smelling discharge or swelling. If these symptoms arise, they may signal serious postoperative complications.
How Barrie Tan ENT Head & Neck Surgery Can Help
ENT specialist Barrie Tan can confirm whether stapes fixation is causing hearing loss due to otosclerosis and explain whether monitoring, hearing aids, stapedotomy, or another option is appropriate.
Dr Barrie Tan is a Senior Consultant ENT Specialist at Gleneagles Hospital in Singapore, where he practices hearing loss and ear surgery. He previously served as Head of the Department of Otolaryngology and Director of the Centre for Hearing and Ear Implants at Singapore General Hospital.
If stapes surgery is suitable, Dr Tan will explain the anaesthetic, surgical approach, prosthesis, expected hearing range, recovery precautions and individual risks. He will provide a thorough assessment to determine your suitability for surgery and your post-operative care.
If gradual hearing loss, tinnitus, or diagnosed otosclerosis affects daily communication, contact Barrie Tan ENT Head & Neck Surgery for an assessment at Gleneagles Hospital. A consultation can clarify the cause of the hearing loss and help you make an informed choice about your hearing.
FAQs
How long does it take to hear after a stapedotomy?
You may notice some hearing improvement after the packing is removed, often within one to three weeks, but you shouldn’t judge the result that early. Swelling, fluid and healing can make your hearing fluctuate. Hearing may take up to three months to stabilise, and the postoperative audiogram is usually performed after the ear has had time to heal.
How risky is a stapedectomy?
A stapedectomy is effective for many appropriately selected patients, with published hearing-improvement rates commonly ranging from about 80% to 95%, but it has the same important risk categories as a stapedotomy. These include dizziness, taste disturbance, tinnitus, eardrum injury and worse hearing. Severe hearing loss in the operated ear is uncommon but can occur. Your surgeon will explain the risks that apply to your hearing and anatomy.
How long should you keep your ears dry after a stapedectomy?
Keep the operated ear dry until your surgeon confirms that the canal, eardrum and any incision have healed. This is often several weeks. Use the water protection your surgical team recommends when showering, and avoid swimming until you have been cleared.
How many years does a stapedectomy last?
The prosthesis is intended to remain in place permanently and can provide useful hearing for many years or decades. There is no guaranteed lifespan. Hearing may decline if the otosclerosis progresses, inner ear hearing changes with age, scar tissue forms, or the prosthesis moves. A new hearing test can identify the cause and show whether a hearing aid or revision surgery may help.
