Stapedectomy

Find out what happens when you have an operation to replace the damaged bone and joining the bones together again in your middle ear, your hearing should improve.

What is it?

Each ear is made up of three parts. There is the outer ear which you can see, and which gathers the sound.

Further in, the outer ear joins the middle ear on each side of the head which contains the ear drum.

Deeper still, there is an inner ear on each side. The sound vibration goes down the ear tube, which is part of the outer ear, into the middle ear on that side.

The ear drum stretches across the deepest part of the ear tube between the outer ear and the middle ear and vibrates.

The drum is about a third of an inch (8mm) across. It is made of thin skin, like the top of a real drum. The vibration of the ear drum is transferred to three very small bones which are just behind it in the middle ear.

These three bones fit together like levers and transfer the vibration to the fluid of the inner ear so that you can hear. The last of these small bones (the one closest to the inner ear) is the stapes.

Your hearing difficulty is because there is growth of bone on the stapes which makes it inflexible and stuck to the other small bones. Because of this, the vibration does not get transferred to the inner ear and you can't hear well.

This disease is called otosclerosis from the Greek words oto which means ear and sclerosis which means hardening. By replacing the damaged bone and joining the bones together again, your hearing should improve.

The operation

You will have a general anaesthetic and be completely asleep.

The surgeon will shine a microscope into your ear, and the operation will be carried out inside the ear passage using very fine instruments.

A cut will be made round the ear drum which is then lifted up. The surgeon will remove the top part of the stapes bone and replace it with a 'plastic' bone. When the bones have been joined together again, the ear drum will be put back in place, and a dressing soaked in antibiotic solution will be placed in the ear passage.

Sometimes the surgeon will make a small cut in the edge of the ear lobe and use some of the fat from inside to help seal up the inside of the ear. The cut is closed up with stitches.

Because you are asleep you will not feel any pain during the operation. You will be in the hospital for four or five days depending upon your progress.

Any alternatives?

Apart from this operation, the only other way to help you with your hearing is for you to use a hearing aid.

Before the operation

Stop smoking and get your weight down if you are overweight.

If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control.

Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT).

Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation.

Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you

If you take aspirin or other medication that contains this particular ingredient, you need to let your doctor know and stop taking it one week before the operation. This is because aspirin is a blood-thinner and can cause bleeding.

On the ward, you will be checked for past illnesses and will have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.

Please tell the doctors and nurses of any allergies to tablets, medicines or dressings.

You will have the operation explained to you and will be asked to fill in an operation consent form. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.

Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.

Before the operation and as part of the consent process, you may be asked to give permission for any 'left over' pieces to be used for medical research that have been approved by the hospital. It is entirely up to you to allow this or not.

Many hospitals now run special preadmission clinics, where you visit for an hour or two, a week or so before the operation for these checks.

If you have a cold in the week before your admission to hospital, please telephone the ward and let the ward sister know. The operation will usually be put off, and you will be given time to get better before being sent for again. You will need to get over your cold before you have your operation because by having a general anaesthetic the cold could turn into a serious chest infection.

After – in hospital

Your ear will be a little sore after the operation. There may be some discomfort in your ear when opening and closing your mouth, or if you lie on the ear. You will be given an injection or tablets to control this discomfort. Ask for more if the pain is not well controlled or if it gets worse.

A general anaesthetic may make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time.

You must not blow your nose, and you must not stifle any sneezing. Blowing your nose or trying to stop a sneeze will increase the pressure underneath the ear drum, and could push the new 'bone' out of place.

You will be on bed rest, lying flat with no pillow for the first 24 hours after the operation. The next day you will be given one pillow and so on until you are comfortable sitting up.

You may have some dizziness for the first 24 hours after the operation, but this is not very common. Medicine can be given to stop the dizziness.

You may notice a strange squelching, buzzing or popping noise in your ear. This is usually due to the dressing in the ear, it is expected and you should not worry about it.

Some soreness or stiffness when opening your mouth is common after ear operations.

You must be careful when taking a shower and washing your hair that you do not get the ear wet. The dressing in the ear passage must stay in place undisturbed for about 10 days.

You will be given an appointment to come back to the ENT (ear, nose and throat) outpatient clinic about 10 days after the operation, when the surgeon will remove the dressing from the ear passage.

The surgeon will examine your ear carefully and test your hearing and will tell you whether the operation has been successful. The nurses will advise about sick notes, certificates etc.

After – at home

Take two painkiller tablets every six hours to control any pain or discomfort. It is better to take paracetamol and not aspirin, which can cause bleeding.

To begin with avoid any sudden jarring movements such as running down stairs. Be sure to keep the ear dry and do not go swimming. You may feel rather tired for a week or so, but this will steadily improve.

You should be able to go back to work after a couple of weeks. If you have a dusty job you should take precautions against getting dust or dirt in the ear. You will be advised about this.

Providing you have no dizziness you can drive as soon as you are fit to leave the hospital.

Possible complications

As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs.

The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Provided the advice given above is followed, you are unlikely to have any problems.

There is a small risk that the ear may bleed when you get home. If this happens come back to the ward.

If possible try and avoid catching a cold in the first month or so after your operation. Try and avoid contact with friends or relatives who have colds. If you catch a cold you should go to your doctor for antibiotics as there is a risk that a cold could lead to an ear infection.

If the ear becomes very painful, or you experience some continuous discharge from the ear which is bloodstained, yellow or green, thick or smelly, or if you get a temperature or bad headache, it most probably means that the ear is infected and you should return to the ward. The infection is usually settled by taking antibiotics for a couple of weeks.

Very rarely, the infection can be serious and can spread around the area of the operation or in your bloodstream. If this happens, you will need to come back to hospital and have it treated with intravenous antibiotics – through a small plastic tube placed in a vein in your arm.

Rarely, a nerve that runs in the middle ear can be stretched during this operation and this can result in lack of taste or a metallic taste on the tongue on the side of the operation. This usually gets better as time goes by.

There are four very uncommon but very serious complications following this operation even if surgically it is done in the best possible way:

  • complete deafness of the operated ear
  • permanent dizziness
  • permanent ringing or buzzing noise on the operated ear
  • paralysis of your face muscles on the side of the operation.

    If you get any of these complications your doctors will discuss further treatment options with you.

    About 90 per cent of patients experience a significant hearing improvement after this operation whereas 8 per cent experience some improvement but not as good as expected. Finally, hearing in 1 to 2 per cent of patients gets worse after a stapedectomy.

    General advice

    We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little.

    If you have any queries or problems, please ask the doctors or nurses.

    This content is imported from Third party. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

    Based on a text by Surgery Door

    Last updated

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