Stapes Surgery

Procedures & Operations

What is Stapes Surgery and Why Might You Need It

In general, stapes surgery is offered as an option for adults with otosclerosis who have been fully informed about the alternatives including hearing aids and observation, and who also understand the risks of the surgery.

Otosclerosis is a condition affecting the stapes bone, one of the three hearing bones in the middle ear. It affects the joint of the bone causing it to become more rigid and so reduces its ability to vibrate, which reduces your hearing. It is a condition that affects women more than men, and can sometimes run in families. Typically, this condition will affect people in early adult life and may progress to varying degrees of severity.

Stapes surgery is rarely done in infants or children with congenital stapes fixation. The reason for this is that there is a risk of permanent hearing loss following stapes surgery and so the vast majority of ear surgeons will elect to wait to offer stapes surgery to patients with congenital stapes fixation when they become adults and can participate in the decision making process and give informed consent.

The Surgery Explained

The operation is usually carried out under general anaesthetic (fast asleep) and takes just over one hour. There is usually a small external incision. During the surgery I occasionally need to take a piece of vein from the back of one of your hands which will leave a small scar.

The eardrum has to be peeled back (anterior tympanotomy) to gain access to the middle ear and the bones of hearing. It is only at this stage that the exact cause of the hearing loss can be confirmed. Occasionally a different cause may be found for which an operation may not be appropriate; if this is the case the operation is stopped and the hearing will be no different. In the majority of cases the diagnosis is confirmed as otosclerosis and part of the stapes bone is then removed and replaced with an artificial piston (prosthesis).

What to Expect Following Your Surgery

Any stitches (in the hand) that need to come out will be removed after a week. A dressing will be left in the ear canal for one to two weeks. You will be able to go home a day or two after the operation, but you will need to rest quietly at home for about two weeks.

You will be given post-operative instructions along the following lines:

  1. Stay off work for a minimum of seven days but up to two weeks may be necessary. You can be given a sick note by the hospital if you need one – please ask for this before you leave the ward.
  2. Avoid vigorous exercise for at least 2 weeks.
  3. Keep the ear and scar dry when washing. Cotton wool smeared in Vaseline is an effective ear plug. Avoid swimming until given the all clear. Change the cotton wool in the ear if it becomes dirty but be careful not to pull the dressing out with it – get someone to help. If some of the dressing is pulled out cut off the bit hanging out; if a whole piece comes out contact the ward.
  4. Minimise pressure changes in the ear – avoid vigorous nose blowing, sneeze with your mouth open and don’t fly for at least two months after surgery.
  5. Complete any course of antibiotics you are given.

Following your operation, you may suffer from:

Pain: A headache around the ear is normal and you will need pain relief for a few days. This will be supplied to you on leaving hospital.

Discharge from the ear canal: Some discharge, often blood stained, is common in the first few days but then dries up.

Muffled hearing:  This is because of the packing in the ear and tinnitus (noise in the ear) is sometimes worsened temporarily.

Disturbed balance:  Immediately after the operation some unsteadiness commonly occurs but does not usually last more than a day or so. If dizziness occurs after you have gone home you should contact the hospital.

Infection:  This can occur at the site of the skin cut or in the middle ear causing increased pain, discharge, swelling and fever. Seek attention if you are concerned this may be developing.

Taste disturbance: occasionally this is noticed due to damage to a small nerve that crosses the middle ear. It is unlikely to be a long-term problem even if the nerve has to be cut in order to perform the operation.

Facial weakness: disturbance to the facial nerve occurs extremely rarely in this type of surgery and would cause weakness of the muscles of the face on the side of the operation. It may be either temporary or permanent.

To view and/or download further information relating to this procedure, please go to the Patient Information Leaflets section of this website.