Stapedectomy: Overview

The human ear consists of three parts: the inner ear, middle ear, and outer ear. There are bones in the middle ear called the ossicles, which carry sound vibrations from the eardrum (tympanic membrane) to the inner ear (oval window) so that sound can be sent to the brain.

As the ossicles vibrate, the fluid of the inner ear moves behind the oval window and the brain understands that movement as sound. The three ossicle bones are called the hammer (malleus), the anvil (incus), and the stirrup bone (stapes). The stapes bone is the smallest bone in the human body.

Otosclerosis is a condition in which abnormal bone overgrowth of the ossicles causes the bones to fuse together, limiting vibrations. As a result, the ossicles cannot transmit sound, causing hearing loss. Otosclerosis more commonly affects both ears, but it can affect just one ear. This condition is treated with stapedectomy.

Nurse holding anesthesia mask in operating room

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What Is Stapedectomy Surgery?

A stapedectomy is performed to remove the diseased stapes and replace it with an artificial implant. The surgery takes about 90 minutes and the steps of the surgery are as follows:

  • The surgeon uses a microscope throughout the procedure to view the ossicles through the opening of the external ear. 
  • Numbing medicine is used around and in the ear, and patients will not be put fully to sleep with anesthesia. However, they may receive medicine to help them relax.
  • A small incision is made into the eardrum. 
  • Small instruments are used to separate and remove the stapes from the malleus and incus. 
  • A tiny implant made of plastic or wire that matches the stirrup shape of the stapes is implanted in place of the diseased bone.
  • The surgeon may take a small piece of fat from behind the outer ear to seal over the incision and then the eardrum is moved back into place.
  • Cotton packing or dissolvable packing will be placed into the ear as a dressing to absorb draining fluid.

Stapedectomy inner ear surgery is for both children and adults. It is a scheduled outpatient elective surgery, meaning most people go home after having the surgery. If otosclerosis affects both ears, the ear with poorer hearing will be operated on first, with surgery on the other ear taking place at a later date.

Contraindications

The surgeon will determine if someone is an appropriate candidate for surgery. You are not a good candidate for stapedectomy surgery if you have:

  • Functional hearing in only one ear (complete hearing loss in the other ear)
  • Active infection in the middle or outer ear
  • A diagnosis of Meniere's disease, a disorder of the inner ear that causes vertigo and hearing loss, combined with balance issues and high-frequency hearing loss, in which you cannot hear high-pitched sounds

Potential Risks

As with any surgery, there are risks to undergoing stapedectomy surgery:

  • Changes in taste
  • Dizziness or vertigo
  • Ringing in the ears (tinnitus)
  • Sensitivity to loud noise
  • Injury to the facial nerve
  • Infection

Stapedectomy vs. Hearing Aids for Otorosclerosis

Hearing aids are an alternative to stapedectomy. One study found that the lifetime cost of using hearing aids was less than the cost of stapedectomy, but hearing aids were less likely to be chosen by younger patients because of the inconvenience and stigma associated with hearing aids.

Surgery is usually covered by insurance, while hearing aids often are either not covered or are only partially covered. Overall, the high success rate of stapedectomy surgery and low risk are often seen as more beneficial to patients compared to hearing aids.

Purpose of Stapedectomy Surgery

People diagnosed with otosclerosis that has caused hearing loss may qualify for stapedectomy. Early symptoms of otosclerosis include difficulty hearing in conversations, while chewing, or in noisy environments.

Otosclerosis is diagnosed with a hearing test, a physical exam by an otolaryngologist (an ear, nose, and throat doctor), and a CT (computed tomography) scan to look at the bones of the ear. For people with minimal hearing loss, the first step is to monitor your hearing over time with follow-up at the doctor’s office.

How to Prepare

Before surgery, make sure any questions are answered by the surgeon. You will need someone to drive you home on the day of the surgery. Do not eat or drink anything after midnight before the surgery. Smoking and drinking alcohol should be avoided prior to surgery as they can interact with anesthesia medications.

What to Expect on the Day of Surgery

The surgeon will use local anesthesia and apply numbing medication to the ear that's being operated on. This allows the surgeon to check your hearing at the end of the surgery.

The surgery is estimated to last about 90 minutes. After the surgery, patients are monitored in the recovery room for a short period of time until they are sent home. 

Recovery

Your hearing may be better immediately after the surgery. It should improve dramatically over the next few weeks to months. There may be feelings of fullness in your ear while the ear is healing.

Packing is removed from the ear one to two weeks after the surgery. It is normal to experience bloody fluid draining from the ear for one to three days following the removal of the packing. It is important to not get water in the ear in the first few days following the surgery. You will notice a sensitivity to noise as you recover, so noisy environments should be avoided.

Long-Term Care

Stapedectomy recovery time is different for each person, but there are standard precautions everyone should take as they heal. For at least one week after surgery, patients should avoid:

  • Returning to work
  • Performing strenuous activities
  • Making sudden head movements
  • Bending

Do not submerge your ears under water for at least four to six weeks. When showering, wear a soft silicone earplug that does not go deep into the ear to prevent water from getting in the ears.

Slowly increase walking as tolerated. Exercise and lifting anything that may cause strain, including groceries and children, will be limited for the first four weeks following surgery. It is safe to fly in an airplane three weeks after the surgery, but this should be approved by your surgeon first. It is essential to attend all follow-up appointments with the surgeon following your stapedectomy.

Summary

Stapedectomy is performed to help improve hearing for people who have otosclerosis, in which abnormal bones grow around the stapes. During the procedure, a surgeon replaces your stapes with a prosthesis. It's an outpatient, elective procedure, so you will go home the same day after the surgery is completed. Hearing aids are an alternative treatment for people who don't want to undergo surgery.

A Word From Verywell

Otosclerosis is a condition that affects the middle ear bones, leading to progressive hearing loss. While stapedectomy has some risks, it is a highly successful surgery that can permanently restore hearing for people diagnosed with otosclerosis. The risks and benefits of surgery should be discussed before proceeding with surgery.

Frequently Asked Questions

Does stapedectomy improve hearing?

Yes. Typically, 90% of patients have significantly better hearing after the surgery. A small percentage of patients will recover only partial hearing, have no change in hearing level, or have worse hearing after the surgery. Hearing aids can help improve hearing for people who do not want to undergo surgery or are not good candidates for surgery.

What helps with sleep after stapedectomy?

Rest whenever you feel tired and get plenty of sleep after surgery. Use two to three pillows to elevate your head, or sleep in a reclining chair to keep your head elevated.

Is a stapedectomy prosthesis permanent?

Yes, a stapedectomy prosthesis is considered a permanent implant. Rarely, some patients require revision surgery.

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Article Sources
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  2. Mount Sinai. Otosclerosis and stapedectomy.

  3. Gillard DM, Harris JP. Cost-effectiveness of Stapedectomy vs Hearing Aids in the Treatment of OtosclerosisJAMA Otolaryngol Head Neck Surg. 2020;146(1):42–48. doi:10.1001/jamaoto.2019.3221

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  5. My Health Alberta. Stapedectomy: What to expect at home. Updated April 15, 2020.