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Stapedotomy – Surgery for Otosclerosis

Stapedotomy is a microsurgical procedure of the middle ear used to treat otosclerosis, restoring hearing by inserting a small prosthesis into the stapes footplate.

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Things worth knowing about "Stapedotomy"

Stapedotomy is a microsurgical procedure of the middle ear used to treat otosclerosis, restoring hearing by inserting a small prosthesis into the stapes footplate.

What is Stapedotomy?

Stapedotomy is a minimally invasive microsurgical procedure performed on the middle ear. During the operation, a small hole is drilled into the footplate of the stapes -- one of the three tiny ossicles (hearing bones) of the middle ear -- and a miniature prosthesis is inserted to restore the transmission of sound vibrations to the inner ear. Stapedotomy is the gold-standard surgical treatment for otosclerosis, a condition in which abnormal bone growth causes the stapes to become fixed and immobile.

Causes and Indications

The primary indication for stapedotomy is otosclerosis. In this condition, abnormal remodeling of the bone surrounding the stapes footplate leads to its fixation at the oval window -- the entry point to the inner ear. As a result, sound can no longer be efficiently conducted from the middle ear to the inner ear, leading to progressive conductive hearing loss.

Otosclerosis as the leading indication
Progressive conductive hearing loss
Reduced or absent mobility of the stapes
Insufficient benefit from hearing aids or conservative management

Surgical Procedure

Stapedotomy is typically performed under general anesthesia or local anesthesia with sedation and lasts approximately 30 to 60 minutes. The surgeon accesses the middle ear through the external ear canal using an operating microscope. The eardrum is gently folded back to expose the ossicles and confirm the diagnosis of stapes fixation.

A precise hole (approximately 0.4 to 0.8 mm in diameter) is then made in the stapes footplate using a laser or fine drill. A small Teflon piston prosthesis -- or a prosthesis made from another biocompatible material -- is placed through this opening and attached to the long process of the incus (the adjacent ossicle). This prosthesis takes over the function of the stapes and re-establishes the acoustic connection to the fluid-filled inner ear. The eardrum is repositioned and typically heals without sutures.

Stapedotomy vs. Stapedectomy

Stapedectomy is an older surgical technique in which the entire stapes footplate is removed and the oval window is covered with a tissue graft. In contrast, stapedotomy preserves most of the footplate and creates only a small opening. Stapedotomy is now the preferred approach due to its lower risk of inner ear damage and comparable or superior hearing outcomes.

Outcomes and Success Rates

Stapedotomy is a highly successful procedure. More than 90% of patients experience a significant improvement in hearing after surgery. In many cases, hearing can be restored to near-normal levels. Improvement is often noticeable within the first few days or weeks, although some swelling and pressure sensation may temporarily affect hearing during the initial recovery phase.

Risks and Complications

As with any surgical procedure, stapedotomy carries certain risks, though serious complications are uncommon:

Dizziness or vertigo in the days following surgery
Temporary or permanent deterioration of hearing
Tinnitus (ringing in the ears)
Rare: injury to the facial nerve or the chorda tympani (affecting taste sensation)
Prosthesis displacement
Perilymphatic fistula (leakage of inner ear fluid)
In very rare cases: complete hearing loss in the operated ear

Aftercare and Recovery

Following surgery, patients are advised to avoid strenuous physical activity, diving, and air travel for several weeks. The operated ear should be kept dry and protected from infection. Regular follow-up appointments with an ear, nose, and throat (ENT) specialist are essential to monitor healing and assess hearing recovery. Most patients can return to light daily activities within a few days after the procedure.

References

Declau F, Van de Heyning P. Otosclerosis and Stapedotomy. In: Stupp R, Raad J (eds.). Otolaryngology -- Head and Neck Surgery. Springer, 2022.
Merkus P et al. European consensus on the definitions, diagnosis and treatment of otosclerosis. Clinical Otolaryngology, 2020; 45(1): 7-14.
Cummings CW et al. Cummings Otolaryngology -- Head and Neck Surgery. 7th ed. Elsevier, 2021.

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