Stapedectomy Surgery

Three tiny bones carry sound across the middle ear, and the stapes is the last and smallest of them. It sits in a window in the wall of the inner ear and works like a piston, pushing fluid inside the cochlea with every sound wave. The operation replaces it with a prosthesis that does the same job.

Your surgeon removes the arch of the stapes, makes a precise opening in its footplate, and hooks a small piston of titanium, platinum or teflon onto the bone above it so that the piston's tip sits in that opening. Sound passes down the chain and through the piston into the inner ear.

In most centres the opening in the footplate is a fine hole made with a laser or a fine drill instead of removing the whole plate, which is safer and is why the operation is often called a stapedotomy. The prosthesis is permanent and does not need changing. Everything is done through the ear canal, so there is no external cut and no visible scar.

This is a Day Care operation under local anaesthetic. The ear canal and drum are numbed by injection, usually with sedation to keep you relaxed, and you stay awake. Working with an awake patient lets your surgeon test your hearing during the operation and ask you about dizziness at the moment it matters.

You will hear the surgery, and some of it is loud. Drilling and suction conducted straight into the ear sound far louder than they are. Your surgeon will tell you what is coming, and it is worth asking beforehand so nothing takes you by surprise.

The operation takes forty-five to ninety minutes. It is done entirely through the ear canal under a microscope: the eardrum is lifted like a flap, the bones are inspected, the prosthesis is placed, the drum is laid back down and packing is placed in the canal.

You rest for two to three hours, are checked for dizziness, and go home the same day with painkillers and instructions. Arrange for somebody to drive you.

Expect to feel unsteady for the first two or three days, and mild dizziness on sudden head movement can continue for a week or two. Get up slowly, and do not drive until it has gone completely.

The ear is packed, so hearing will be muffled for two to four weeks, and judging the result before the packing has gone is the commonest source of unnecessary worry. Hearing usually improves noticeably once the canal is clear, and continues settling over two to three months, when a formal test is done.

Most people take one to two weeks off desk work and three to four weeks off heavy work. The rules that protect the prosthesis matter more than the rest: do not blow your nose for three weeks, open your mouth when you sneeze, avoid heavy lifting and straining for three to four weeks, and avoid flying and diving for about six weeks. Keep the ear dry until you are told otherwise.

Temporary taste disturbance, popping and crackling during healing are all common.