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Stapedoplasty – Surgery for Otosclerosis

Stapedoplasty is a microsurgical procedure of the middle ear used to treat otosclerosis. The fixed stapes bone is replaced with a prosthesis to restore hearing function.

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Things worth knowing about "Stapedoplasty"

Stapedoplasty is a microsurgical procedure of the middle ear used to treat otosclerosis. The fixed stapes bone is replaced with a prosthesis to restore hearing function.

What is Stapedoplasty?

Stapedoplasty (also referred to as stapes surgery or stapedectomy/stapedotomy) is a microsurgical procedure performed on the middle ear. Its primary goal is to restore hearing that has been impaired due to otosclerosis – a condition in which the stapes, one of the three tiny bones (ossicles) in the middle ear, becomes abnormally fixed due to bony overgrowth. This fixation prevents the stapes from vibrating freely, leading to progressive conductive hearing loss. During stapedoplasty, the immobile stapes is removed and replaced with a small prosthesis that restores sound transmission to the inner ear.

Causes and Indications

The primary indication for stapedoplasty is otosclerosis, a hereditary disorder characterized by abnormal bone remodeling in the middle ear region. The condition tends to run in families and affects women more often than men. As the stapes becomes increasingly immobilized within the oval window – the junction between the middle and inner ear – sound waves can no longer be transmitted effectively.

Progressive conductive hearing loss due to otosclerosis
Confirmed stapedial fixation on audiometry and tympanometry
Insufficient benefit from hearing aids or other conservative measures

Surgical Procedure

Stapedoplasty is typically performed under general or local anesthesia and takes approximately 30 to 60 minutes. The entire operation is carried out under an operating microscope, given the extremely small structures involved in middle ear surgery.

Surgical Steps

Access to the middle ear via the ear canal (transmeatal approach)
Elevation of the eardrum to expose the ossicular chain
Removal of the fixed stapes (stapedectomy) or partial removal with perforation of the footplate (stapedotomy)
Insertion of a titanium or Teflon prosthesis that bridges the incus and the oval window, restoring sound conduction
Repositioning and securing of the eardrum

Stapedectomy vs. Stapedotomy

In the traditional stapedectomy, the entire stapes is removed. The more modern technique, stapedotomy, preserves the footplate and creates only a small perforation through which the prosthesis is inserted. Stapedotomy is now considered the standard approach as it is less traumatic to the inner ear and is associated with a lower risk of sensorineural hearing loss.

Outcomes and Prognosis

Stapedoplasty is one of the most successful procedures in otolaryngology. In appropriately selected patients, a significant improvement in hearing is achieved in more than 90% of cases. Many patients experience near-complete normalization of their hearing ability. Results are generally stable over the long term.

Risks and Possible Complications

As with any surgical procedure, stapedoplasty carries certain risks. These are generally rare but should be discussed thoroughly before the operation:

Dizziness and balance disturbances (typically transient in the first days after surgery)
Tinnitus (ringing in the ears), usually temporary but occasionally persistent
Sensorineural hearing loss as a rare but serious complication
Complete hearing loss in the operated ear (very rare)
Taste disturbances due to involvement of the chorda tympani nerve (usually temporary)
Prosthesis displacement or dislocation
Infection or eardrum perforation

Aftercare and Recovery

Following surgery, patients typically remain in the hospital for one to two days. During the first weeks of recovery, patients are advised to avoid strenuous physical activity, air travel, and nose blowing to support proper healing. A first audiological follow-up (hearing test) is usually scheduled a few weeks after surgery. Final hearing outcomes generally stabilize within two to three months of the procedure.

References

Deutsche Gesellschaft fur Hals-Nasen-Ohren-Heilkunde – Guidelines on Otosclerosis and Stapes Surgery. www.hno.org
Declau F, Van Spaendonck M, Timmermans JP et al. – Prevalence of otosclerosis in an unselected series of temporal bones. Otol Neurotol. 2001;22(5):596-602. PubMed PMID: 11568668
Salvinelli F, Casale M, Greco F et al. – Stapedotomy outcomes in otosclerosis: a comparative study. Eur Arch Otorhinolaryngol. 2004;261(7):371-374. PubMed PMID: 14735343

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