Stapedectomy

What is a STAPEDECTOMY?

A Stapedectomy is the name of an operation to treat a condition called OTOSCLEROSIS. Most people nowadays perform a STAPEDOTOMY. A STAPEDOTOMY means making a hole in the stapes footplate. The term STAPEDECTOMY is historical and comes from a time when the whole footplate was removed and the hole was either grafted and a piston placed between the graft and the incus; or filled with fat attached to a piston which attached to the incus. The modern technique of making a small hole just slightly larger than the size of the piston is probably safer. The term STAPEDECTOMY has stuck and tends to be used interchangeably with STAPEDOTOMY.

How effective is a Stapedectomy operation?

A successful operation will get rid of the CONDUCTIVE part of your hearing loss. In many patients the inner ear is normal so the nerve hearing is normal. In this case the operation can return the hearing to normal. If you have a nerve hearing loss as well a successful operation will only return the hearing to as good as your nerve hearing is. See MIXED HEARING LOSS. A stapedectomy will be successful in the majority of patients who have it done.

What are the risks of a Stapedectomy?

There are number of risks associated with a Stapedectomy. These risks occur rarely but can cause significant disability if they do occur. The risks include: Dead Ear – a total loss of hearing in the operated ear, Chronic balance problem, Tinnitus – a whistling noise in the ear, Taste disturbance – usually temporary but could be permanent, Facial Nerve damage – the facial nerve controls movement of one side of the face. The nerve is right next to the stapes bone but damage to it is extremely rare. Have a look at the information sheet I give to all my patients – click on the image

What happens in a Stapedectomy?

There are different ways of doing a stapedectomy operation. I will describe the way I do it. I perform the operation under a general anaesthetic. It is performed down the ear canal. A cut is made in the ear canal skin which is lifted up to the edge of the ear drum. The ear drum is lifted up. The first two bones are touched to make sure that they move easily. The stapes bone is touched to confirm that it is stiff. Occasionally you can see the stapes bone. Usually you can only see a small part of it so some bone of the ear canal needs to be removed. This bone is very close to the nerve of taste. If this nerve is stretched or damaged it can cause a strange taste in the mouth. This is usually temporary. Once the stapes bone is fully exposed the joint between the stapes bone and the incus bone is separated. A tendon attached to the stapes bone is cut. I then use a LASER to cut through the arch of the stapes bone. This avoids the possible transmission of trauma into the inner ear. Previously the arch of the stapes was snapped downwards or cut with scissors. Both these manoeuvres risk loosening or fracturing the footplate. If this happens the operation may sometimes need to be abandoned. The laser improves the safety of this part of the operation. The arch of the stapes bone is removed. Any tiny blood vessels running over the footplate are ‘cauterised’ with the laser. This avoids possible bleeding into the inner ear when the hole is made. The gap between the incus bone and the footplate of the stapes bone is measured. A prosthesis called a ‘stapes piston’ is cut to the right length. Sometimes a small piece of fat is taken from the back of the ear lobe. The cut in the back of the ear lobe is closed with absorbable stitches. An area of the footplate is ‘weakened’ with the laser reducing the chances of the footplate fracturing when drilled. A hole of either 0.5 or 0.7mm diameter is drilled in the footplate of the stapes bone. One end of the stapes piston is placed into the hole in the footplate. The other end of the stapes piston is hooked over the incus bone and crimped into place using the laser. Either some blood or the ear lobe fat is placed around the piston where it goes through the hole in the footplate. This helps make a seal to prevent fluid from leaking out of the inner ear. The ear drum is replaced. A dressing is placed in the ear canal. This German animation shows what happens in a stapedectomy. Turn the volume down and enjoy – it is very short.

Video of the Stapedectomy operation

The video below is of a patients right ear. The patient is lying on their back. The operation is performed through a speculum and using an operating microscope. The patient is under General Anaesthetic. The operation takes about 50 minutes.

The arch of the stapes bone needs to be removed, and I use a laser for this as I feel is the safest way to ‘cut’ the arch of the stapes bone without causing any damage to the footplate below. The laser is also used to ‘weaken’ an area of the footplate before a hole is drilled in it.

What happens after the operation?

I usually keep patients in overnight to rest for the first 12-24 hours after the operation. I then ask patents to have 2 weeks off work and to take things easy. This means avoiding any strenuous activity. During this early healing phase strenuous activity could possibly cause an increase of pressure inside the head and result in a leak of the inner ear fluid, which could lead to dizziness or hearing loss. I will usually see my patients after 1-2 weeks in the outpatient clinic to remove the dressing in the ear canal. I then tend to see them again 4-5 weeks later to ensure that everything has healed well and to perform a hearing test. You may notice the improvement in hearing as soon as the dressing is removed. However sometimes the middle ear can fill with blood and this takes a while to reabsorb so the full hearing improvement may not be appreciated for a few weeks. Usually by 6 weeks you will know the final outcome. After 2 weeks most of my patients can return to work and slowly build up to normal duties. Of course this is very dependant on the patient and what they do. If you have this operation done it is essential that you discuss your individual circumstances with your surgeon. I encourage my patients to keep water out of their ear canal for 2 months from the date of surgery. At the end of this time if the ear canal has healed up I no longer insist on water precautions.

Are there any restrictions after a Stapedectomy?

I suggest that my patients never Scuba Dive after a stapedectomy operation. I also advise against flying in unpressurised planes – especially an activity like aerial acrobatics. This is a very precautionary approach. The worry is that a sudden significant pressure change could cause a leak of inner ear fluid around the piston. The area is usually well sealed with scar tissue but does represent a site of potential weakness. Other surgeons may disagree and it is essential you discuss activities after a stapedectomy with your surgeon.

Can you operate on both ears?

Yes you can – but I would never operate on both ears at the same time. I like to leave at least 9 – 12 months between operations.