Stapedectomy

What the Operation Is

Otosclerosis is a condition in which abnormal bone growth fixes the stapes — the smallest bone in the body, located in the middle ear — to the surrounding bony wall. The stapes normally transmits vibration from the eardrum to the inner ear; when it becomes fixed, sound cannot pass through, producing a progressive conductive hearing loss. Otosclerosis often affects both ears and tends to worsen over years.

In a stapedectomy, a small hole is made in the fixed footplate of the stapes and a tiny prosthesis (typically titanium or platinum-fluoroplastic, around 0.5 mm in diameter) is inserted to bridge the gap. Sound transmission is restored mechanically by the prosthesis, bypassing the fixed bone. The operation is performed under microscopic magnification, usually entirely through the ear canal, and typically takes 30 to 60 minutes under general anaesthetic.

Risks & Complications

1. Permanent hearing loss (1–2%)

There is a 1 to 2% risk of permanent total hearing loss in the operated ear. Although this has not happened in my practice so far, it is a recognised risk in any surgeon's practice and the most important risk to understand before proceeding. The risk is particularly relevant if you have only one functional ear — most surgeons (including me) operate on the worse ear and leave the better ear alone for this reason.

2. Vertigo and dizziness

Mild vertigo and dizziness in the days after surgery are common and usually settle within a few weeks. In extreme cases, vertigo can persist longer — particularly if triggered by loud noises (Tullio phenomenon), which may indicate a problem with the prosthesis or a perilymph fistula. Protracted vertigo has not happened to one of my patients but is theoretically possible and may need a revision operation.

3. Persistent nerve hearing loss

Otosclerosis sometimes affects the inner ear (cochlea) as well as the stapes, producing sensorineural hearing loss alongside the conductive loss. Stapedectomy improves the conductive component but cannot fix the nerve component. Some patients therefore still need hearing aids even after a successful stapedectomy.

4. Vein graft scar on the hand

I often harvest a small vein graft from the back of the hand to use as a seal around the prosthesis. This leaves a small linear scar and may produce a small bruise. The graft reduces the risk of a granulation tissue complication (around 1%) — granulation tissue formation can otherwise lead to permanent hearing loss, vertigo and other symptoms.

5. Chorda tympani nerve damage and taste change

The chorda tympani — a small nerve carrying taste fibres from the front two-thirds of the tongue — runs through the middle ear within the operative field. It can sometimes be irritated or divided during the operation. The usual result is a metallic taste on one side of the tongue lasting two to three weeks. Long-term effects are very rare, and even with complete division of this nerve, appreciation of food is rarely substantially compromised in the long term.

6. Facial nerve damage

The facial nerve — controlling the muscles of facial expression — runs within a few millimetres of the operative field. If during surgery there is any sign that damaging this nerve is becoming a risk, my usual practice is to abandon the operation. There is, of course, a small risk in any operation on the ear of damaging this nerve, which would cause weakness on one side of the face.

7. Prosthesis dislodgement

Later in life there is a chance of the prosthesis coming out of the hole made in the stapes footplate, which would require a revision operation. The initial risk is reduced by packing inside the ear which is removed approximately three weeks after surgery. I recommend the packing is not removed earlier than three weeks. I also recommend no flying or anything that may pop the ears for at least three months — pressure changes can dislodge the prosthesis and cause permanent hearing loss.

8. Visible scar

This operation is typically performed within the ear canal and therefore there is usually no visible scar around the ear. In patients with a narrow ear canal, an external incision behind the ear may occasionally be required.

9. Pain and dizziness from packing

Pain after this operation is minimal. Mild dizziness from the packing inside the ear and from the anaesthetic typically lasts a day or so.

10. Anaesthetic risks

Standard general-anaesthetic risks apply, which the anaesthetist will discuss separately.

Aftercare

• Keep the ear dry for at least three weeks.
• Packing removal at approximately three weeks in clinic.
• Painkillers are rarely needed beyond paracetamol.
• Avoid pressure changes — no flying, no diving, no rapid altitude changes for at least three months.
• Avoid heavy lifting and straining for two weeks.
• Hearing improvement is usually noticeable once the packing is removed, although the final result develops over several weeks.

When to Call the Hospital or Attend A&E

• Sudden change in hearing.
• Severe vertigo, especially triggered by loud sounds.
• Persistent facial weakness or asymmetry.
• Fluid discharge from the ear.
• Severe pain that is not relieved by simple painkillers.

Booking, Consent and Next Steps

Stapedectomy is one of the more delicate operations I perform, and is offered after detailed audiometric and clinical assessment confirms otosclerosis. The secretarial team can arrange a consultation. See also Hearing Loss and Cartilage Tympanoplasty Consent.