Advanced Stapedectomy Surgery - Inner Ear Surgery

Which diagnostic tests are necessary before stapedectomy?

If you are experiencing any degree of hearing loss, you should undergo the following diagnostic tests to determine the cause of hearing problems and the appropriate treatment for it. The diagnostic procedure generally begins with a medical history and physical examination. 

Otosclerosis is a hereditary disease and patients who have a family history are more likely to suffer from the condition. During physical examination, the ENT specialist will look in the ear canal using an endoscope to determine whether the patient’s symptoms are due to an infection, sclerosis, trauma, etc. If the patient has otosclerosis in both ears, the ear with worse hearing is operated first.

The ENT may suggest the following hearing tests to determine the severity of hearing loss in the patient:

• Audiometry helps test hearing ability in a range of tones.
• Tuning fork test helps determine how well the sound is transmitted through the middle ear bones and the mastoid.
• Tympanometry helps assess the movement of the eardrum to determine if the hearing problems are a result of tympanum trauma or deformity.

Diagnostic tests also commonly required before a stapedectomy include imaging tests like CT scan, X-ray, etc., as they help the ENT to visualize the internal structures and learn about the extent of the sclerosis to finalize the best type of prosthesis for the patient.

How to prepare for the surgery?

Before undergoing a stapedectomy, the patient should be completely aware of the pros and cons of the surgery. There is a very slight chance that the patient may have permanent sensorineural hearing loss after the surgery, so they should be prepared for that. Patients should also be advised properly regarding postoperative recovery so they can avoid complications.

Some general preparative measures the patient can take before the surgery are:

• Stop smoking at least a couple of weeks before your surgery is scheduled as tobacco decreases the recuperative ability of the body.
• Maintain a healthy weight and diet. Perform mild to moderate exercise.
• If you have any pre-existing conditions then get approval for the surgery from your general physician/primary care provider.

When is stapedectomy required?

As discussed above, most patients are suggested stapedectomy for treatment of otosclerosis, i.e., the fusion of stapes with the surrounding bone. Other indications of stapedectomy are:

• Conductive hearing loss
• Airborne gap of at least 30dB
• Good cochlear reserve demonstrated by good speech discrimination
• Tympanosclerosis
• Osteogenesis imperfecta 
• Paget’s disease

Common symptoms for which stapedectomy may be necessary are:

• Trouble hearing low-pitched sounds, especially when someone is whispering
• Balance issues
• Vertigo
• Tinnitus – ringing sound in the ears
• Dizziness

Mild symptoms are usually managed conservatively, but in severe cases, the patients may need surgery for relief. In children,  stapedectomy may be required for congenital stapedial fixation, or juvenile otosclerosis.

How can stapedectomy benefit you?

Patients with hearing loss due to otosclerosis can benefit from stapedectomy, as it can reverse the hearing loss, or enable them to use hearing aids. In children, stapedectomy is especially beneficial over conservative treatments as it prevents the long-term effects of pediatric hearing loss without impeding their activities or increasing the risk of future hearing loss.

When is a stapedectomy not recommended?

There are some cases in which a stapedectomy is not recommended, such as:

• Patient already has complete hearing loss in one ear
• Patient has severe swelling and fluid buildup in the ear
• Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive Schwartz sign/Flemingo’s pink sign
• Conductive deafness due to Ehlers-Danlos Syndrome (EDS)
• Patient has a severely retracted eardrum
• Diabetes or other medical problems
• Mild hearing loss
• Active ear infection
• Deformity in the inner ear
• Pregnancy
• Patients with high risk of future head injuries like boxers, wrestlers, etc.

What to expect after the stapedectomy?

Generally, it takes about 3-4 weeks for the patients to have noticeable improvement in hearing, so do not panic if there is no difference in hearing immediately after the surgery.

Most patients have mild pain or discomfort after the surgery for a few days. Normally, over-the-counter pain medications are enough to soothe the patient’s pain, but if the patient has severe pain, it may be a sign of postsurgical complications, and the patient should consult their doctor immediately.

Most patients are able to go home on the same day nowadays, and are suggested rest and very light activity for the first few days. Complete recovery can take upto 6 weeks, but most patients can return to daily life activities much before that. 

There may be a little bloody discharge in the first couple of days, you can place small cotton balls in the ear to absorb it. If there is any sign of infection, your surgeon may advise antibiotic drops to avoid it. 

Some patients may also have unsteadiness, numbness around the ear, and popping, clicking or pulsating sounds in the ear for the first few days. 

After the surgery, patients have to avoid straining the ear canal so they must – not lift heavy weights, avoid staining while coughing or sneezing, and avoid inserting anything in the ear canal- till they have completely recovered.

What are recovery tips for stapedectomy surgery?

Most patients can resume work and their daily life within 1 week, if they have a desk job or lead a sedentary  lifestyle, but they have to wait at least 3-4 weeks before performing strenuous activities, heavy lifting, exercises, running, etc. 

Some tips that you should follow to improve recovery after stapedectomy surgery are:

• Keep your ear dry, especially before your eardrum has completely healed. While bathing or showering, close the ear canal using a silicone plug or cotton ball covered by Vaseline. Once you’re done, remove the cotton ball and clean the outer ear region using a cotton ball.
• Avoid flying until your ear has completely healed, as the air pressure changes while flying can dislodge the prosthesis. Most patients are eligible to fly around 3 weeks after the surgery.
• Don’t use earbuds until the ear has healed. If you want to, you can get approval from your ENT for over-the-ear earphones.
• You can resume a normal diet immediately, but if you have an upset stomach or constipation, you should eat healthier low-spice foods to avoid straining.
• Drink plenty of water and electrolytes to maintain hydration and take your medicines as prescribed.

What are the complications associated with stapedectomy?

While 80-90% of people do not have any complications after the surgery, in rare cases, the patient may suffer from complications. Most stapedectomy complications disappear within a few days on their own or can be managed if diagnosed in time, but if not, they can result in severe hearing loss. Some potential complications of stapedectomy are:

• Failure of the treatment
• Worsening of the hearing after the surgery
• Severe dizziness or lightheadedness lasting more than 3 days
• Nerve irritation or damage leading to loss of taste or altered taste sensation in the operative side of tongue
• Development of tinnitus
• Loss of hearing regarding high frequency sounds
• Facial palsy
• Eardrum perforation

Absence of improvement in hearing and additional loss of hearing are the most common signs of treatment failure. You should consult a doctor immediately if you exhibit the following symptoms:

• Severe vertigo, dizziness, or balance problems
• Signs of post-surgery infection, like heavy pain, bleeding, discharge, or swelling
• Muscle weakness or loss of sensation on the operative side

The patient’s ears may be noise sensitive during the first few days, so they should avoid pubs, concerts, and other noisy areas. They should also avoid activities like swimming, contact sports, scuba diving, etc., till they have received approval from the doctor.