Advanced Stapedectomy Surgery - Inner Ear Surgery

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.

What Happens During Stapedectomy?

Step 1 · 30-60 mins

Hospital Admission

The patient arrives at the hospital or surgical center on the scheduled day of surgery.

Registration and admission formalities are completed.

Vital signs such as blood pressure, pulse, temperature, and oxygen levels are checked.

Hearing test results, CT scan (if required), blood tests, and other pre-operative investigations are reviewed.

Step 2 · 20–40 mins

Pre-surgery Preparation

The ENT surgeon reviews the patient's hearing loss, diagnosis of otosclerosis, and confirms the surgical plan.

The anesthetist performs a final pre-anesthesia assessment.

Consent forms are signed after discussing the procedure, expected benefits, recovery, and possible risks.

The ear is cleaned and prepared for surgery.

An IV line is started for fluids, antibiotics, and medications.

Step 3 · 10–15 mins

Anesthesia Administration

The patient is taken to the operation theatre.

Local anesthesia with sedation or general anesthesia is administered, depending on the patient's condition and surgeon's preference.

The patient remains comfortable and pain-free throughout the procedure.

Step 4 · 1-2 Hours

Stapedectomy Procedure Begins

The surgeon accesses the middle ear through the ear canal, avoiding external incisions.

The eardrum is gently lifted to expose the middle ear bones (ossicles).

The immobilized stapes bone is partially or completely removed.

A tiny prosthetic implant is positioned to replace the stapes and restore sound transmission to the inner ear.

The eardrum is carefully repositioned, and the ear canal is packed with a protective dressing to support healing.

Step 5 · 1–2 Hours

Recovery Room Observation

The patient is shifted to the recovery room for monitoring.

Nurses monitor blood pressure, pulse, oxygen levels, hearing, balance, and pain control.

The patient is observed for dizziness, nausea, or bleeding before discharge.

Step 6 · Same Day or Within 24 Hours

Discharge & Recovery

Most patients return home on the same day or within 24 hours after stapedectomy.

Pain relief medicines, antibiotics (if prescribed), and ear care instructions are provided.

The patient is advised to keep the ear dry, avoid forceful nose blowing, heavy lifting, flying, swimming, and strenuous activities until approved by the surgeon.

Follow-up appointments are scheduled to remove ear packing, assess healing, and perform hearing tests to evaluate improvement.

Patients should seek immediate medical attention if they experience severe dizziness, sudden hearing loss, persistent ear discharge, heavy bleeding, high fever, or severe ear pain after surgery.

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.