Rao's ENTRao's ENT

Stapes Surgery

What is a stapes surgery?

Our hearing ability depends a lot on a group of three tiny little bones – malleus, incus and stapes- present in the middle ear. A sound comes, the eardrum vibrates, these bones vibrate, and the sound waves are conducted to the inner ear for further transmission to the brain.  However, when a disease called otosclerosis strikes the middle ear, the stapes – which is the smallest bone of this trio and also of our body – goes static, stops vibrating and the sound conduction part of hearing mechanism is disturbed leading to hearing loss. Stapes surgery (or stapedectomy) is a microsurgery that involves construction of an alternative sound conduction mechanism to bypass the fixed stapes to restore hearing.

If your hearing loss is due to a fixed stapes caused by otoscelorsis, a stapes surgery can improve your quality of life by freeing you of your dependence on cumbersome hearing aids. Stapes surgery is an elective procedure (not a life-saving surgery) that you can choose to have or not have. A stapes surgery will not stop progression of otosclerosis but it will improve your hearing a great deal by constructing an alternative sound conducting mechanism.

This hour-long surgery is usually performed under general anaesthesia, though some surgeons may prefer to operate with local anaesthesia. Most of the times, the surgery is done through the ear canal and does not need any visible incisions. At times, the surgeon may have to harvest sealing material from behind the ear and a small cut may become necessary. During the surgery, the surgeon will remove the top section of the stapes bone and make a small opening at the base of the bone -also called the footplate- using a conventional instrument or the far more advanced CO2 laser/ skeeter drill (at our hospital, we employ CO2 laser or Skeeter Drill for this surgery). Then he will set in place a plastic or metal prosthesis in this opening for sound conduction from the other two ossicles. Once done, the area of the surgery will be sealed using graft material and the ear canal will be packed with gelfoam for healing to begin.

Experienced surgeons have a success rate of 80 -90% in a stapes surgery which means that eight to nine out of every ten patients will get improved hearing ability up to the level of the inner ear’s hearing capacity. Actually, if the stapes surgery is being done under local anaesthesia and the patient is awake on the operating table, he or she will start hearing while still inside the operation theatre.

Pre-operative instructions for a stapes surgery are quite similar to those for myringoplasty and many other ear surgeries.

After the ENT surgeon has set a date for your stapes surgery, you are advised the following precautions:

  • Till the preceding night of the surgery, duly take all medications prescribed to you by the ENT surgeon. Bring along any remaining medicines in original packaging when you check in for surgery the next morning. Also bring along any non-prescription medications in their original packaging that you are currently taking.
  • Get a good night’s sleep. Do not eat anything at all from midnight onwards prior to the surgery day.
  • Make sure you bring your hospital file with you at the time of the check-in for surgery duly including all required test reports such as the major surgical profile, audiological evaluation reports, pre- anaesthetic check up sheet, radiological investigation films and reports (X-ray, CT scan, MRI, PET scan etc.) and any others investigations advised by your ENT surgeon. We advise you to ready this file a day before the surgery.
  • Shampoo your hair before the surgery day. Male patients are advised to ensure a short hair cut.
  • You should be accompanied by an attendant. We advise bringing along a close family member.
  • Please ensure that you report at the hospital at least three hours prior to your surgery’s scheduled timing.
  • Report at the reception desk in time and the hospital staff will guide you through the next steps.
  • If you have felt any changes in your physical condition such as cough, cold, fever or throat pain, be sure to mention it to your doctor and anaesthetist. If you are allergic to any drugs, be very sure to mention that as well.

Please read the following information carefully to get further clarity on the pre-operative instructions including special instructions for patients with diabetes, respiratory or cardiac problems.

Just like the preoperative ones, the postoperative instructions for a stapes surgery too are very similar to those for a myringoplasty and other ear surgeries.

First 24 hours:

  • Take complete bed rest. Do not lie on the side of the operated ear.
  • You are not allowed any drink or food till 4-5 hours after the surgery. After the surgical staff gives the go-ahead, you can sip water. A while later you can take milk or Horlicks etc. However, caffeinated beverages such as tea, coffee or aerated drinks are to be avoided as these can cause gastric irritation when consumed on an empty stomach. You can start a semi-solid diet in moderate quantities after 12 hours and move to soft diet (avoiding hard foods such dried peas or chicken bones) on the second day. You can resume normal food from third day onwards.
  • Take care not to bend or make any sudden head movements as this can induce giddiness and vomiting. Please also keep in mind that mild giddiness, nausea and vomiting are fairly common for up to 10 days after the surgery.

Precautions from the day of discharge up to 10th day:

  • Take all medications on schedule as prescribed by your surgeon.
  • Do not oil your hair.
  • Do not clean your ear.
  • Stay away from people with cold or cough.
  • Do not blow your nose with excessive force.
  • If you have to sneeze, do so with your mouth open.
  • Do not have a head bath for a full one month after the surgery. No water should get into your ear.
  • Do not sleep on the operated side for a month afterwards.
  • Do not undertake strenuous work for a month afterwards.
  • Do not travel on bumpy roads riding on scooter, motorcycle or auto-rickshaw etc.
  • Do not travel by air for 1 month after the surgery.

The following activities are allowed:

  • A daily bath that does not wet or spoil your head bandage till the time it is on your head.
  • Resumption of regular office work after 3 days of surgery (unless specially advised by your operating surgeon)

When you should contact the hospital immediately:

  • If your prescription medicines cause any drug reactions such as rashes or stomach upset etc, call your doctor immediately.
  • If your ear bandage becomes loose or gets soiled between days 1 and 7 i.e. from operation till suture removal, visit your doctor for a fresh bandage.

Precautions after suture removal:

  • Strictly follow all the dos and don’ts mentioned above.
  • Wear cotton balls or ear plugs over the ear opening.
  • A follow-up audiological evaluation is advised 3 months from the date of surgery.

When you should contact the hospital immediately:

  • If you get any severe pain in the ear or surrounding region.
  • If you get any swelling in or around the ear.
  • If you feel dizzy or are vomiting.
  • If you feel facial weakness.
  • If your ear is oozing excessive discharge.
  • If you are hit by sudden deafness.

Timeline for specific activity resumption:

  • Head bath: 1 month after surgery
  • Office work/ housework: 3 days from the date of surgery (your ear bandage will stay on for 7 days)
  • Air travel: 1 month after surgery
  • Swimming and other water activities: 3 months after surgery. However high pressure activities such as diving or deep water swimming etc should be avoided. Do get your surgeon’s permission before planning any such activity.

A stapes surgery carries some risks that you should know prior to giving consent to this treatment. Please consult your surgeon for further risk evaluation in your individual case.

  • Loss of hearing: An occasional patient (1 patient in every100 for experienced surgeons) can suffer from further hearing impairment due to damage to the inner ear. This hearing impairment can be to a severe extent (not remediable even by hearing aid) in the operated ear. Therefore surgeons usually operate upon the poorer hearing ear first to minimize risk.
  • Dizziness: Dizziness for a few hours after the surgery is normal. In some cases, it may last longer.
  • Taste disturbance: The taste nerve runs close to the eardrum and may sustain some damage to cause abnormal taste on one side of the tongue. While this taste disturbance is mostly a temporary phenomenon, it may be permanent in some cases (up to 1 in 10 cases)./p>
  • Tinnitus: If the hearing loss worsens, the patient may suffer from tinnitus or noises in the ear.
  • Allergic reaction to ear dressings: Occasionally the ear may show allergy to the dressings in the ear canal leading to a red, swollen and inflamed pinna (outer ear). Consult your surgeon for dressing removal and settling down of the allergic reaction.
  • Other complications: As a stapes surgery entails some degree of risk toward total loss of hearing, along with possible disturbance of balance or taste, it could have serious implications for certain careers (think chef, musician, teacher, sportsperson, dancer etc). We advise you to discuss all your concerns with your ENT surgeon well in advance. Some ENT surgeons also advise the patient against scuba diving, sky diving or use of firearms after a stapes surgery.

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