A stapes operation can be performed to improve hearing in patients who have a “frozen” or “stuck” stapes bone. This usually occurs in patients who have the condition called otosclerosis, but can occur in other hereditary conditions or in patients who have had very severe middle ear infections or previous surgeries. The stapes is the last hearing bone in the chain of bones in the middle ear, and it is normally mobile and attached by a ligament to an opening of the bone that houses the inner ear, called the oval window. A frozen stapes bone causes a mechanical or conductive hearing loss.
The operation to allow sound to pass into the inner ear again is called a stapedectomy, or stapedotomy, depending on the size of hole made into the oval window, but the operations are pretty much the same. The surgery is usually performed on an out-patient basis and takes about an hour. It is usually performed with sedation, although some patients require general anesthesia.
In most cases, the operation can be completed by working through the ear canal, although sometimes an incision needs to be made behind the ear if the ear canal is small or the anatomy is different. A microscope and laser are used.
The ear is completely numbed and incisions are made in the ear canal and the drum is lifted up out of the way. The diagnosis is confirmed by making sure that the other bones are normal. A vein graft from the hand or arm or a tissue graft from behind the ear is obtained through a tiny incision. The top of the stapes bone is removed and an opening is made into the base, or footplate of the stapes bone. A prosthesis made of titanium is placed between the hole and the incus bone and a tissue graft is used to help seal the hole. The drum is put down into position, the hearing is tested and packing is placed in the ear canal.
After surgery, the patient stays in bed in the hospital for a few hours to prevent nausea and vomiting. The nurses then help the patient get up and walk and if there is no significant dizziness or nausea, the patient can be discharged home.
The patient’s activity is fairly restricted for the first week, and then a gradual return to activity can occur, but heavy exercise, staining, blowing the nose, or lifting anything more than 10 pounds needs to be avoided for 4-6 weeks. The packing is removed in the office one week after surgery and the hearing gradually returns over the next month. Water needs to be kept out of the ear for 2-3 weeks.