Stapedectomy Surgery
Stapedectomy surgery is a highly specialized ear procedure performed to restore hearing in patients with otosclerosis, a condition where abnormal bone growth around the stapes bone prevents normal sound conduction. By replacing the fixed stapes with a prosthetic device, this surgery allows sound vibrations to reach the inner ear effectively and significantly improves hearing.
History & Definition
Stapedectomy emerged in the 1950s as a breakthrough treatment for conductive hearing loss caused by otosclerosis. The modern technique was pioneered by Dr. John Shea Jr. in 1956, who successfully replaced the immobilized stapes with a prosthesis. This innovation transformed otologic surgery and laid the foundation for later refinements such as laser-assisted stapedotomy, which is widely practiced today.
Causes & Indications
- Otosclerosis: Abnormal bone remodeling causing fixation of the stapes bone
- Progressive Conductive Hearing Loss: Especially in young and middle-aged adults
- Difficulty Hearing Speech: Particularly in noisy environments
- Family History: Genetic predisposition to otosclerosis
- Reduced Benefit from Hearing Aids: When surgical correction is preferred
In India, otosclerosis is a common cause of adult conductive hearing loss, and stapedectomy is routinely performed at tertiary ENT centres with excellent outcomes.
Pre-Operative Evaluation
- Detailed ENT examination and otoscopic evaluation
- Pure tone audiometry to assess conductive hearing loss
- Speech audiometry for functional hearing assessment
- Tympanometry to evaluate stapes mobility
- High-resolution CT scan of the temporal bone (when indicated)
- General medical and anesthetic fitness evaluation
Surgical Technique
Stapedectomy or stapedotomy is performed under general or local anesthesia using high-powered operating microscopes. The immobilized stapes is either partially or completely bypassed and replaced with a prosthesis that transmits sound vibrations to the inner ear. Laser-assisted stapedotomy is commonly used today to improve precision and safety.
Recent Advances
- Laser-assisted stapedotomy using CO₂ or KTP lasers
- High-definition operating microscopes
- Biocompatible prostheses made from titanium and Teflon
- Endoscopic ear surgery for improved visualization
- Intraoperative facial nerve and auditory monitoring
Possible Risks & Complications
- Temporary dizziness or vertigo
- Tinnitus (ringing in the ears)
- Taste disturbance due to chorda tympani irritation
- Rare facial nerve irritation
- Persistent or recurrent hearing loss
- Very rare risk of inner ear injury
Outcomes
Stapedectomy surgery has one of the highest success rates in ear surgery. Most patients experience significant hearing improvement with closure of the air-bone gap. Long-term hearing stability and high patient satisfaction are commonly reported. Indian clinical studies show outcomes comparable to global standards when surgery is performed by experienced otologic surgeons.
Conclusion
Stapedectomy and laser-assisted stapedotomy are highly effective surgical treatments for otosclerosis-related hearing loss. With advances in microsurgical techniques, laser technology, and prosthesis design, modern stapedectomy offers safe, predictable, and lasting hearing restoration. Careful patient selection and expert surgical care ensure excellent functional outcomes and improved quality of life.