Stapedectomy: what is it and how can it improve my hearing?

A stapedectomy is a surgical procedure for the treatment of hearing loss caused by otosclerosis. In this article, leading ENT surgeon Mr Neil Fergie, explains what is a stapedectomy, what are the risks involved, and why stapedectomy patients are among the most satisfied group of ear surgery patients.

What exactly is a stapedectomy?

A stapedectomy, or stapedotomy, is an operation in which part of the stapes bone is replaced with a small implant. This operation is usually performed when a patient develops a condition called otosclerosis, where the stapes bone is fixed by new bone formation and thus, cannot vibrate freely.

The stapes bone is the last of a chain of three bones behind the ear drum, whose job is to transmit the vibration of the ear drum to the inner ear. When the stapes bone is fixed, it can no longer vibrate well. This surgery aims to replace the function of the fixed bone using an implant.

How exactly does it improve hearing?

By replacing the fixed bone with a freely mobile implant, the vibration from the ear drum can be transmitted effectively once again.

How is it performed?

There are some variations in the technique of the surgery.

In my case, I perform the operation with general anaesthetic, making a small incision - no more than 1cm in length - in a natural skin crease in the opening of the ear canal. After, the ear drum is lifted up and the movement of the three bones behind the ear, carefully assessed. If the stapes is confirmed to be fixed, part of it is removed using a laser. A small hole is then made in the base of the stapes bone, where an implant is placed and then attached to the middle bone (in the chain of three bones behind the ear drum).

In the end, the arch part of the stapes bone is removed, but the base remains in its original state, with a small hole drilled in it.

What are the risks involved?

In general, a stapedectomy works well. Experiencing dizziness immediately after the operation is common, but this usually settles.

However, like in all surgeries, there is an element of risk and this is related to the fact that we are operating on the hearing mechanism. Rather than making the hearing better, there is a possibility that this is not achieved, or, it causes worsening of hearing. In rare cases, complete loss of hearing can occur in the operated ear.

In addition, there is a risk of worsening tinnitus, which is usually temporary, and disturbance of taste on the side of the tongue. This is common and again, temporary.

Even after a successful surgery, there is also a risk that the results of the operation may stop working, months or years later, for a number of reasons, although this is uncommon. Further surgery may be considered in this situation.

If someone is suffering from hearing loss, is this the best option for them?

The best option is not the same for everyone, so a careful and thorough discussion involving all options would take place before a patient decides which one they would like to pursue.

What can patients expect from a stapedectomy?

A stapedectomy is performed as a day case with general anaesthetic. After the operation, patients can expect to feel a bit unsteady. The ear will feel blocked and a little uncomfortable, but not necessarily painful.

Dissolving sutures and dissolving packing are used in the ear. As the packing dissolves and the ear heals, hearing will improve, but patients can experience fluctuations in hearing during this period. Hearing is not usually tested until at least six weeks after the surgery, as it can take up to this time for it to improve.

Patients are usually very happy with the outcome. As a group, they are some of the most pleased patients who have had ear surgery.

Mr Neil Fergie is a highly experienced Nottingham-based ENT surgeon who specialises in several ENT conditions, including hearing loss, tinnitus, tongue tie and tonsillitis. If you're experiencing hearing loss and wish to know more about a stapedectomy surgery, visiting Mr Fergie's Top Doctors profile today.