Stapedectomy

Stapedectomy is performed to reverse the hearing loss caused by damage to the stapes bone in the ear.

The ear consists of three sections, i.e., the outer, middle, and inner ear. Stapes is one of the three bones located behind your eardrum in the middle ear. These bones transmit sound from the outer ear to the inner ear by vibrating. However, in conditions such as otosclerosis, the stapes bone becomes fixed and is unable to vibrate due to excess bone formation. Otosclerosis mostly affects one ear; however, both the ears may also be affected in some individuals.

A hearing aid can be helpful in such a condition; however, some individuals prefer to regain their natural hearing through surgery. In that case, the stapes bone is replaced with a metal or plastic prosthesis, which vibrates like the stapes and continues transmitting sound to the inner ear. When both ears are affected by otosclerosis, the surgery is performed on the ear with poorer hearing.

Read more: Hearing loss causes

Your surgeon may recommend stapedectomy if you have the following symptoms indicative of otosclerosis or brittle bone disease (a genetic disease that weakens the bone causing them to break easily:

• Hearing loss
• Balance problems
• Dizziness
• Roaring, ringing, hissing, or buzzing sensation in the ears or head Read more: Ringing in ears causes

Your surgeon may not recommend this surgery if:

• You cannot tolerate anaesthesia.
• You cannot lay flat due to breathing difficulty.
• You are on blood-thinning drugs such as apixaban, warfarin, edoxaban.
• The ear in which the surgery is to be performed is the only hearing ear.
• Your livelihood depends on your vestibular function, .i.e., sense of balance.
• You have an infection in the middle ear. Read more: Ear infection symptoms
• You have Meniere’s disease, a disease characterised by recurrent dizziness and hearing loss.
• You have severe sensorineural hearing loss, a hearing loss caused due to damage to tiny hairs in the ear, which transmit sound to the brain.
• Your speech discrimination (ability to understand what you hear in a noisy or quiet environment) score is poor.

Before the surgery is conducted, the following preparation is needed:

• Your doctor will first conduct a hearing test to decide whether you are a suitable candidate for the surgery.
• Before the surgery, the surgeon will take your medical history, perform a physical examination, and discuss with you the procedure and risks and benefits associated with the surgery.
• The doctor will ask for a list of all medication that you take along with dose and frequency. Also, tell the details of any medication allergies.
• Inform the doctor if you have a cold or flu during the week prior to surgery.
• Ask someone to take you home from the hospital after surgery.
• Avoid smoking two weeks before and after the surgery as it may delay healing.

This surgery usually does not require any fasting.

This surgery is performed under local anaesthesia, with a numbing medicine that will make you relax but not put you into sleep. The use of local anaesthesia in the ear enables the surgeon to check your hearing right after surgery. The procedure involves the following steps:

• The surgeon will approach your stapes bone through your ear canal using an operating microscope.
• He/she will lift your eardrum to expose the three bones of your middle ear.
• The surgeon will then remove the stapes bone and replace it with a prosthesis.
• Next, he/she will put your eardrum back into its original position and fix it by using packing material. The packing material used is of two types: one that is absorbed by the body after a few days or the one that is required to be removed during a follow-up.
• At the end of the surgery, the surgeon will place a cotton ball in your ear.

The surgery will take 90 minutes, and you will be discharged from the hospital on the same day. Over 90% of individuals show improvement in hearing after this procedure.

You may experience the following after surgery:

• Your hearing may improve right after surgery. However, you may have trouble hearing due to packaging material or swelling. 
• You may feel dizzy right after surgery. This is normal and will gradually decrease in a few days.
• Since the jaw and ear are nearby, you may feel stiffness or soreness around your jaw after surgery. 
• You may also experience a slight pain in your ear.

You can take the following care after the surgery:

• Avoid quick head movements.
• The surgeon may prescribe medicines for ear pain relief. Take them as directed.
• Take soft foods if you experience soreness in the jaw after surgery.
• While lying down, elevate your head at least 30 degrees by keeping two pillows under your head for the next two days. 
• Change the cotton ball daily or as often as required until there is no drainage from your ear. Drainage may persist for a week or more after surgery.
• Avoid swimming after the surgery. While you take a shower, place a cotton ball covered with petroleum jelly in your ear to seal it and prevent the entry of water.
• You should cough or sneeze with an open mouth for one week following surgery. 
• Avoid blowing your nose for a week after surgery. Subsequently, you may blow your nose gently to avoid any strain on the ears.
• Avoid lifting or straining for about six weeks after surgery as it could displace the prosthesis or damage the ear.
• Avoid flying for at least three months after surgery as the changes in pressure during flying may damage the ear.
• You can start exercising gradually with mild exercises as gentle bicycling after two weeks of surgery. You can return to full physical activity after one month of surgery.
• Avoid going to the office for at least a week after surgery since there is a risk of increased exertion and catching an infection.
• It is normal to experience sounds to be too loud or hear popping or cracking sounds as you regain your hearing ability.
• You may also experience abnormal taste following surgery, which may last for about three months or more.

Stapedectomy helps improve your hearing ability so that you do not need to wear a hearing aid.

When to see the doctor?

You should call the doctor immediately if you experience any of the following:

• Fever (>100.5^oF)
• Major hearing loss
• Bleeding that soaks the cotton ball in about 10 minutes or continues for about an hour
• Sudden dizziness
• Dizziness persisting for more than two days
• Increased redness, pain, warmth, or swelling around the ear

This surgery is associated with the following complications:

• Tinnitus: If you have experienced tinnitus before, the condition might remain unchanged, or it may get worse after surgery.
• Abnormal taste: The nerve responsible for the taste sensation of the tip of the tongue passes close to the area of the surgery. This nerve often needs to be either pulled aside or cut. As a result, some people may experience either metallic taste or decreased taste sensation at the tip of the tongue. 
• Vertigo: Most people experience vertigo for 48 hours after surgery. In some cases, the condition may persist longer.
• Facial weakness: Another nerve that runs close to the area of the surgery is the facial nerve, responsible for the movement of the facial muscles. Hence, damage to the facial nerve during surgery may affect the movement of your facial muscle. If the nerve is too close to the area of the surgery, the operation is often discontinued.
• Tear to the eardrum: This may occur during surgery; however, it is often repaired during the same surgery.
• Hearing loss: In rare cases, your hearing may get worse or you may be unable to hear after surgery.

You may require to visit the hospital three weeks after the surgery to remove the packaging material from the ear. The surgeon will ask you to get hearing tests done at periodic intervals following surgery to assess the results of the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.