stapedectomie

Stapedectomy (stapedectomie) is a surgical procedure to improve conductive hearing loss caused by fixation or reduced mobility of the stapes (the stirrup bone) in the middle ear, most commonly due to otosclerosis. In the operation, the immobilized stapes is removed or bypassed and a prosthetic device is placed to restore sound transmission from the eardrum to the inner ear.

Indications and techniques: It is indicated for persistent, stable conductive hearing loss with a mobile inner ear and intact cochlear function, typically due to otosclerosis. Modern practice favors stapedotomy, a technique that creates a small hole in the footplate and inserts a piston or micro-prosthesis to connect the incus to the inner ear, often with a graft to seal the oval window.

Procedure: The operation is usually performed under general anesthesia, though local anesthesia with sedation is possible. A tympanomeatal approach provides access to the middle ear. The stapes footplate is fenestrated or removed, and a prosthesis placed between the incus and the inner ear. The tympanic membrane is closed, and the patient typically recovers within days.

Outcomes and risks: Hearing improvement is achieved in the majority of patients, with a reduction of the air-bone gap in many cases; reported success rates commonly range around 70-90%. Risks include facial nerve injury, sensorineural hearing loss, vertigo, tinnitus, disruption or dislocation of the prosthesis, tympanic membrane problems, and taste disturbance.

Alternatives and follow-up: If surgery is not suitable, options include hearing aids or cochlear implants, depending on cochlear function. Long-term follow-up with audiometric testing is standard to assess hearing and prosthesis integrity.