Ear Surgery for Hearing Loss: Stapedectomy (Replacement of Stapes)

What is a stapedectomy?

A stapedectomy is ear surgery that can be done to treat hearing loss caused by a problem called otosclerosis. Otosclerosis causes a buildup of bone around the stapes (stirrup bone). The buildup of bone keeps the stapes from moving normally, resulting in a type of hearing loss called conductive hearing loss. The surgery is done to replace the stapes with an artificial part. After the surgery, sound can again be transmitted from the eardrum to the inner ear.

This surgery can restore normal hearing in more than 90% of cases.

When is it used?

This operation is used when the main cause of a hearing loss is decreased movement of the stapes (otosclerosis). If both ears have this problem, the ear with worse hearing is treated first.

Not everyone with otosclerosis needs this surgery. Sometimes the hearing loss is not bad enough to require surgery. Sometimes people choose a hearing aid to help their hearing instead of surgery. In some cases the surgery may be done to allow better use of a hearing aid.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Tell your healthcare provider if you have an infection, such as a cold.
• Your healthcare provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Follow any instructions your healthcare provider may give you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for tests or procedures.

What happens during the procedure?

The procedure is usually done at a surgical center or the hospital.

You will be given a local or general anesthetic. A local anesthetic is a drug that numbs the part of your body where you will have the surgery. If you have a local anesthetic, you may also be given a sedative to help you relax. A general anesthetic will relax your muscles, put you to sleep, and prevent you from feeling pain during the operation.

Your healthcare provider will use a powerful microscope to look and work inside the ear. Your provider will make a cut in the ear canal near the eardrum and the eardrum will be lifted away from the middle ear. The three ear bones inside the ear will be checked to make sure that the stapes is the cause of the hearing loss. Then your provider will remove part or all of the stapes. Sometimes a very small drill or laser will be used. Your provider will then put an artificial stapes in the ear. The new stapes will reconnect the 2 other ear bones to the inner ear. The eardrum will then be put back to the correct position. Your provider will put packing in the ear canal.

The surgery usually takes 1 to 1.5 hours.

What happens after the procedure?

Often you can go home on the same day as the surgery. Your healthcare provider will tell you when you can go back to your normal activities. Your provider will give you instructions for what is allowed and what to avoid.

Your hearing may not be much better right after the surgery because of the packing put into your ear at the end of the procedure. Usually you will go back to see your provider 1 week after surgery to have the packing removed. Your hearing may still not seem any better until a month or so after the surgery because of swelling and bruising inside the ear.

You may have dizziness, ringing or buzzing in your ear, or a change in taste for a while after the surgery. The part of your face on the side where you had the surgery may have temporary weakness, but this is very rare.

You will have a hearing test 1 to 2 months after the surgery to see how well you are hearing.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• The eardrum may be damaged and have a hole or tear. You may need more surgery to fix it.
• Your hearing may not be any better after the surgery. This can happen if the artificial stapes slips. Another operation can correct this.
• Your hearing may get worse. It may get so bad that even a hearing aid is not helpful. Fortunately, this is rare.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.