During a stapedectomy, an incision is made in the skin of the ear canal, the skin and eardrum are lifted to expose the stapes bone, and the stapes bone is removed.
An incision is made above the ear and the tissue is removed. The tissue is used to cover the opening created by the stapes bone removal. A prosthesis is put in place where the stapes bone had been and the eardrum and skin of the ear canal are laid back in place.
Who is a candidate for a stapedectomy?
otosclerosis and significant hearing loss are candidates for a stapedectomy. Each patient receives audiometric (hearing) tests, an ear examination and a consultation with the ear surgeon to determine the appropriateness of a stapedectomy.
How long does the surgery take?
The surgery takes about one hour to perform.
How long does it take to hear after surgery?
It generally takes about four weeks for the ear to heal. By the fourth week, patients normally notice an improvement of the hearing.
What restrictions are placed on the patient during the post-operative healing time?
It is important not to undergo any heavy or strenuous activity during this time. Generally, by the next day, patients are up and about. After the first week, patients may resume lighter activities.
Are there different techniques in performing a stapedectomy?
No two surgeons perform the surgery exactly the same way. Virtually all stapedectomies are performed through the ear canal. Some surgeons use a vein from the arm or hand in place of the tissue from above the ear to close the opening created by removal of the stapes. There is a variety of prostheses that can be used, including a stainless steel piston, a wire, or others. Some surgeons remove part of the stapes bone, others essentially all of the stapes bone. Dr Holt’s method includes removal of most or all of the stapes bone, and placement of a Robinson prosthesis in most cases. This prosthesis has been used since the mid 1960's. The results have been excellent. A good surgical outcome is not just a result of the technique used, but also the experience of the surgeon.
Is the prosthesis designed to be permanent?
The prosthesis is designed to be permanent. On occasion, there may be a problem with the healing process and the prosthesis may need to be revised.
Is the surgery performed on an outpatient basis?
Yes. This surgery is performed on an outpatient basis.
Is the stapedectomy considered a painful operation?
Generally, a stapedectomy is not a very painful operation. Medication may be needed for a few days after the surgery.
What are the risks of a stapedectomy?
Any surgical procedure carries potential risks. These risks are discussed with the patient and/or family prior to surgery:
Hearing loss: There is a slight chance of hearing loss in the inner ear. This loss can be complete and permanent.
Dizziness: Some patients experience dizziness that resolves itself within a day of surgery. It is not likely for dizziness to be a persistent problem.
Facial paralysis: The nerve that innervates the muscles of the face courses through the ear. Therefore, there is a slight chance of a facial paralysis. This affects the movement of the facial muscles for closing of the eye, making a smile and raising the forehead. The paralysis could be partial or complete. It may occur immediately after surgery or as a delayed onset. Recovery can be complete or partial.
Tinnitus (noises in the ear): This can occur with surgery, but is an uncommon postoperative problem.
Taste abnormalities: A small nerve courses through the ear that innervates some of the taste and salivary function. After ear surgery, some patients experience an abnormal taste in the mouth or some dryness of the mouth. Many times this problem will improve over time.
It is generally felt that the occurrence of these potential complications is less with surgeons who are well trained in otologic surgery, have experience in performing these surgeries and perform these procedures on a regular basis. Patients should feel free to ask their surgeon about any concerns they may have regarding any complications.
Along with these otologic risks, any surgery carries the risk of anesthesia, bleeding, infection and other, more remote operative problems.
Can surgery be performed in both ears at the same time?
Surgery is performed in one ear at a time. If surgery in the second ear is needed, it can be performed 6 months or more after the initial surgery.
What is a revision stapedectomy?
Sometimes the first surgery is not beneficial and a revision stapedectomy is recommended. This is essentially a stapedectomy that is performed in an ear that has already had one stapes procedure.
Can a stapedectomy be performed in children?
Yes, stapes surgery can be safely performed in children.
Can a stapedectomy be performed for diseases other than otosclerosis?
A stapedectomy is sometimes performed in patients who have a congenital abnormality of the stapes or have sustained a fracture of the stapes from a traumatic incident. However, the most common indication for a stapedectomy is otosclerosis.