Stapedectomy/Stapedotomy

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.

Post-op Care

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.

Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
The eardrum prior to starting the procedure.

Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
The view of the middle ear after lifting up the drum.
Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
The view of the incus and stapes bone after removing some bone of the ear canal.
Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
Removal of the top of the stapes.
The footplate is exposed.
Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
Making a hole (stapedotomy) in to the stapes footplate with a laser.
Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
The stapedotomy is complete.
Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
The stapedotomy is covered with
the a vein graft.
Stapedectomy/Stapedotomy at Ear Associates, San Jose, CA
The stapes prosthesis is in position between the vein over the hole and the incus bone.

Complications

  • Nausea and dizziness: this is common and expected after surgery and is usually mild and short lived. Many medications are given to prevent these and only a few patients feel dizzy beyond the day of surgery. Some patients feel sensitive to motion for a few days. Driving is restricted until this resolves, usually no more than a few days. If severe dizziness occurs, the patient is kept in hospital and given medication until it resolves
  • Temporary change in taste: A nerve of taste runs under the ear drum and has to be moved out of the way during surgery. This can leave a loss of taste, or taste change on the side of the tongue which is usually temporary.
  • No improvement in the hearing, or lack of significant improvement can occur in 2% of cases.
  • High frequency hearing loss can occur in 5-10% but the improvement in other frequencies usually makes up for this.
  • Tinnitus usually improves with hearing improvement after surgery, but in rare cases can occur or worsen.
  • A perforated eardrum or damage to the other ear bones are rare.
  • Facial nerve paralysis is extremely rare.
  • Total loss of hearing can occur in 1% of cases. If this occurs, a conventional hearing aid would not help restore the hearing loss.
  • Some patients develop a recurrence of hearing loss and need to undergo repeat surgery in the future. This probably happens in 5% of patients over their lifetime.
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