stapedectomystapedotomy

Stapedectomy and stapedotomy are ear surgeries that treat conductive hearing loss from stapes fixation, most commonly otosclerosis. By restoring sound transmission from the eardrum to the inner ear, they aim to improve hearing sensitivity and speech understanding.

In a stapedectomy the footplate is removed and a prosthesis bridges the incus to the vestibule. A stapedotomy creates a small fenestra in the footplate and inserts a piston prosthesis through the opening, preserving more of the footplate.

Indications include progressive conductive hearing loss with a normal tympanic membrane and radiologic evidence of stapes fixation, most often otosclerosis. Preoperative assessment uses audiometry, tympanometry, and CT imaging to evaluate the ossicular chain and otic capsule.

The operation is usually performed under general anesthesia, sometimes with local anesthesia. A tympanomeatal approach exposes the ossicular chain. The surgeon fenestrates or removes the footplate and places a prosthesis attached to the incus and connected to the inner ear.

Outcomes are favorable in experienced centers, with many patients showing improved hearing. The air-bone gap often decreases by 15–25 dB, though results vary with patient factors and technique.

Risks include sensorineural hearing loss, vertigo, tinnitus, taste disturbance (chorda tympani), facial nerve injury, perilymph fistula, prosthesis dysfunction, and residual conductive loss.

Recovery typically involves a period of activity restriction and follow-up audiometry. Dizziness may occur temporarily, and patients may use ear drops and avoid pressure changes during healing.

Stapedectomy and stapedotomy emerged in the mid-20th century and remain standard options for otosclerotic hearing loss, continually refined with advances in prosthesis materials and microsurgical techniques.