Stapedectomy

Indications

Treatment of conductive hearing loss due to otosclerosis. 

Procedure

The procedure can be performed under general or local anaesthesia. The middle ear is typically accessed via the canal (permeatal). The stapes footplate (oval window) is identified. The stapes crura are divided and the stapes superstructure is removed. A hole (fenestration) is made in the footplate by laser and/or drill, and a piston is inserted and connected to the long process of the incus.

Length of procedure

Varies from 45 min to 2 hours depending on approach/complexity.

Complications

Pain

Bleeding (rare)

Infection Rare - if BIPP (a bright yellow antiseptic) ribbon is used, this causes a yellow-brown discharge which can be mistaken for infection.

Hearing loss  Stapedectomy carries a small but definite risk of complete sensorineural hearing loss (“a dead ear”).  Surgeons should know their own rate – it is usually around 1%.

Prosthesis loosening This may occur over time in some cases, leading to deterioration in hearing.  Some patients may therefore require a revision procedure.

Facial palsy Rare, but the facial nerve is a hazard particularly when it hangs just above, or even over, the oval window niche.

Taste disturbance The chorda tympani runs across superior tympanic membrane, and should be identified and preserved.  Damage can lead to a metallic taste, although this usually improves over time.

Tinnitus Usually tinnitus improves with stapedectomy, but it can occasionally persist or worsen.

Dizziness Usually a temporary postoperative effect, but occasionally persists.

Perforation of the tympanic membrane.

Reaction to BIPP packing A rare allergic-type reaction to BIPP packing (if used); the patient will have previously been sensitised by similar packing. The pinna and surrounding soft tissues will become hot and red quite soon ie within 24-36 hours of the operation, as distinct from a post-operative cellulitis.

Post-operative management

The patient can usually go home the same day. Follow-up is usually in two weeks for the removal of ear canal dressing. Inform the surgeon if the patient experiences severe vertigo or sudden severe hearing loss.

TTO

Simple analgesia, and ear drops if the surgeon wishes.

 Page last reviewed: 9 December 2019