Stapes Surgery (Stapedotomy)

What is stapes surgery?

Stapes surgery (stapedotomy) is an ear operation that restores, with a small prosthesis, the function of the stirrup bone (stapes) whose movement has been restricted by otosclerosis. The aim is to transmit sound from the middle ear to the inner ear again and to bring hearing closer to the level the inner ear allows.

Sound is transmitted from the eardrum to the inner ear through three small bones (the hammer, anvil and stirrup). In otosclerosis, abnormal bone forms around the base (footplate) of the stirrup bone; the bone becomes fixed and sound does not reach the inner ear well enough. During the operation, the upper part of the fixed bone is removed, a small hole is made in its footplate, and a prosthesis placed in this hole transmits sound to the inner ear. The method is named after this small hole; the older method, in which the whole footplate is removed, is called stapedectomy.

What is otosclerosis and who does it affect?

Otosclerosis is a disease caused by abnormal bone growth around the stirrup bone in the middle ear, leading to slowly progressive hearing loss. Its exact cause is unknown; it is more common in people with a family history of similar hearing loss.

• It usually begins in adolescence or young adulthood.
• It is more common in women; in some women the hearing loss becomes more noticeable during pregnancy.
• It often affects both ears to different degrees; it can also occur in one ear only.
• It mostly causes conductive hearing loss; in some patients the inner ear is also affected and a mixed hearing loss develops.

What are the symptoms?

The most important symptom is reduced hearing that progresses unnoticed over the years.

• Slowly increasing hearing loss in one or both ears
• Ringing in the ear (tinnitus); its severity does not always match the degree of hearing loss
• In some patients, hearing conversations more easily in noisy surroundings
• Dizziness is rare

On examination the eardrum usually looks normal. For this reason, hearing tests should be carried out in people with slowly progressive hearing loss even though the eardrum is intact.

How is it diagnosed?

The diagnosis is made with an ear examination and hearing tests; imaging is added if needed.

• Ear examination: the eardrum is examined with a microscope or endoscope; other causes of hearing loss (a hole in the eardrum, fluid in the middle ear, earwax) are ruled out.
• Audiometry (hearing test): the degree and type of loss are determined; how well the inner ear works (bone conduction hearing) is decisive in the decision to operate.
• Tympanometry and acoustic reflex: middle ear pressure and the reflex linked to the stirrup bone are measured; in otosclerosis the reflex is usually absent.
• CT scan: requested in selected patients to assess the extent of the disease.

Hearing aid or surgery?

There are two valid options in otosclerosis: a hearing aid and stapes surgery. Medication does not restore lost hearing. With mild loss, monitoring with hearing tests alone may be enough.

• Hearing aid: amplifies sound and carries no surgical risk; it is preferred for patients who do not want surgery or whose inner ear is significantly affected.
• Stapes surgery: considered when the loss is mainly conductive and inner ear function is good; when successful, the aim is hearing without an aid in the operated ear.

If both ears are affected, the ear that hears less is usually operated on first; both ears are not operated on at the same time. If the second ear needs surgery, it is planned after the result of the first operation is known, usually after waiting up to a year. The decision is made together, based on the test results, the expected hearing gain and the patient’s preference.

How is the operation performed?

Stapes surgery is performed through the ear canal under a microscope (in some cases an endoscope) and usually takes about one hour. No large visible incision is needed.

1. General or local anaesthesia is used; under local anaesthesia, hearing can be checked during the operation. The type of anaesthesia is agreed together before surgery.
2. The eardrum is lifted at one edge to reach the middle ear.
3. The upper part of the fixed stirrup bone is removed.
4. A small hole is made in the footplate of the bone with a micro-drill or laser.
5. A thin prosthesis (piston) attached to the anvil bone is placed in this hole.
6. The eardrum is laid back in place and packing is placed in the ear canal.

The details of the prosthesis used and its MRI compatibility are given to you in writing after the operation.

Recovery

Most patients are discharged the same day or the next day. In the first days hearing is reduced because of the packing in the ear; hearing improves over the following weeks and may take up to three months to settle.

Period	What to expect and what to do
First hours and first days	Mild dizziness and nausea are common and soon ease. A spinning sensation with sudden head movements may last a few weeks.
First weeks	Keep the ear dry; when showering, place cotton wool with petroleum jelly in the ear. Do not blow your nose, or blow it very gently if necessary; keep your mouth open when sneezing. Avoid heavy lifting and straining.
Weeks 1–3	The ear packing and any stitches are removed at a check-up.
First 3 months	Hearing settles gradually; the hearing test is repeated at a check-up.
Air travel	Postponed until your doctor approves; avoid flying with a cold.

If you develop sudden hearing loss, severe or increasing dizziness or severe pain, contact your doctor without waiting for your check-up appointment.

Success and risks

In published series, hearing improves significantly in the large majority of patients; the ENT UK patient information reports a good result in more than 80 per cent. Results vary from person to person; the expected gain is discussed before surgery based on your test results.

• No improvement in hearing as expected (about 1 in 10 patients in the literature)
• Further reduction in hearing due to inner ear involvement (about 1 in 20 patients); severe or total hearing loss in the operated ear is rare (about 1 in 100 patients)
• Dizziness: common in the first hours; rarely long-lasting
• A change in taste on the operated side of the tongue: common and mostly temporary
• New tinnitus is a small risk; tinnitus present before surgery often decreases
• Temporary weakness of the facial nerve is rare, and permanent weakness very rare
• A tear in the eardrum or displacement of the prosthesis; a second operation (revision) may be needed later

Because of these risks, surgery is usually performed on the ear that hears less, and both ears are not operated on at the same time. For other ear problems such as eardrum perforations and ossicle damage, see the tympanoplasty page.

How does the process work with Prof. Dr. Öner Çelik?

1. Consultation: at the clinic in Suadiye, the eardrum is examined with a microscope or endoscope; audiometry, tympanometry and acoustic reflex tests are planned.
2. Decision: based on the test results, the hearing aid and surgical options, the expected hearing gain and the risks are discussed together.
3. Surgery: performed at Maltepe University Hospital; most patients are discharged the same day or the next day.
4. Check-ups: packing follow-up and post-operative hearing tests are carried out at the clinic.

For other topics in ear surgery see the ear surgery page, and for details the your treatment in Istanbul page.