Stapes Surgery

Indications

When this may be discussed

• Otosclerosis causing progressive conductive hearing loss confirmed by audiometry — typically a gradually worsening hearing loss in one or both ears, most commonly in women between the ages of 20 and 45, often with a family history.
• An air-bone gap of at least 15 dB across three or more frequencies on audiometry, with good cochlear reserve demonstrated by adequate bone conduction thresholds and speech discrimination.
• Absent stapedial reflexes on tympanometry, consistent with stapes fixation.
• Patients who prefer a surgical solution over long-term hearing aid use, or for whom hearing aids provide inadequate benefit.
• Bilateral otosclerosis — the worse-hearing ear is operated on first. The second ear may be considered six months later once recovery of the first is confirmed.
• Note: stapes surgery corrects the conductive component of hearing loss only. Any sensorineural component caused by cochlear otosclerosis does not improve with surgery and should be discussed with your surgeon before deciding on treatment.

What to expect

Before and on the day

Assessment involves pure-tone audiometry, tympanometry with stapedial reflex testing, and tuning fork tests. CT imaging of the temporal bone is occasionally requested to assess the extent of otosclerosis and confirm anatomy. Surgery is performed under general or local anaesthetic as day surgery, typically taking 45 to 90 minutes. The procedure is carried out entirely through the ear canal — there are no external incisions, scars, or bruising. Using an operating microscope or endoscope, the surgeon accesses the middle ear through a small incision inside the ear canal. The preferred modern technique is stapedotomy, in which a precisely measured small hole is created in the fixed stapes footplate and a tiny titanium or teflon prosthesis is inserted to restore the ossicular chain. Stapedectomy, in which the stapes footplate is partially or fully removed, is performed in selected cases. Hearing improvement is typically noticeable within days of surgery as post-operative swelling resolves, with further improvement over the following weeks.