At a glance
- Purpose
- To restore hearing lost because the stapes bone has become fixed.
- Technique
- Ear microsurgery (stapedotomy) with laser and a prosthesis.
- Anaesthesia
- Local with sedation.
- Duration
- About half an hour.
- Hospital stay
- Day surgery or one night.
- Back to normal
- Within 1 to 2 weeks; avoid straining and flying for the first weeks.
What is otosclerosis?
The middle ear has three tiny bones that carry sound from the eardrum to the inner ear: the malleus, incus and stapes. In otosclerosis, abnormal bone growth around the stapes fixes it in place so that it can no longer vibrate. Sound does not pass through properly, causing conductive hearing loss that tends to get worse over the years.
It is more common in women, usually starts between the ages of 20 and 45, often runs in families and can get worse during pregnancy. It frequently affects both ears.
Symptoms
- Gradual hearing loss in one or both ears.
- Tinnitus (ringing or buzzing).
- Hearing better in noisy places.
- Sometimes mild unsteadiness or dizziness.
Diagnosis
- Otomicroscopy: the eardrum usually looks normal, which helps to distinguish it from other causes.
- Full hearing test (audiometry), which shows the conductive loss and how much hearing can be recovered.
- Tympanometry and stapedial reflexes, which are usually abnormal.
- Ear CT scan in selected cases, to confirm the diagnosis and plan surgery.
Laser stapedotomy
This microsurgery is performed through the ear canal under a microscope. The upper part of the fixed stapes is removed, a laser makes a tiny opening in its base, and a very small prosthesis is placed to carry sound to the inner ear again. The laser allows great precision with less handling of the inner ear.
The operation is done under local anaesthetic with sedation in the operating theatre of the Clínica Sagrada Familia in Barcelona, and takes about half an hour.
Recovery
- First few days: a blocked feeling in the ear, some unsteadiness and noises are normal. Material in the ear canal is removed at the clinic.
- Care: keep the ear dry, do not blow your nose hard, sneeze with your mouth open and avoid straining.
- Hearing: improvement starts within days or weeks and is confirmed with a follow-up hearing test.
- Flying and sport: when we advise, usually after the first check-ups.
Risks
Stapedotomy has good results, but there are risks you should know about: temporary dizziness, a temporary change in taste, eardrum perforation and, uncommonly, worse hearing. That is why it should be performed by a surgeon experienced in ear surgery, and the decision taken only after the hearing-aid alternative has been explained properly.
Frequently asked questions
Is surgery better than a hearing aid?
Both are valid options. A hearing aid amplifies sound and has no surgical risk, but has to be worn all the time. Surgery corrects the faulty mechanism and, if successful, allows you to hear without a hearing aid. The choice depends on your hearing, the other ear, your age and your preferences, after both options have been explained properly.
What are the results of stapedotomy?
In experienced hands the great majority of patients improve their hearing significantly. There is a small risk of hearing getting worse, which is why the worse-hearing ear is usually operated on first.
Will my tinnitus improve too?
In many patients tinnitus decreases as hearing improves, but this cannot be guaranteed.
When can I fly home after surgery?
Not in the first few days. We will tell you when it is safe to fly, usually after the first check-up. If you are coming from abroad, we will plan the dates with you in advance.
Can both ears be operated on?
Yes, but not at the same time. If the first ear goes well and the second also needs it, it is considered several months later.
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Before surgery you receive the informed consent document of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC), which explains the technique, its alternatives and its risks.
Guidance written by the team of Dr. Carlos Magriñá, an ENT surgeon with more than 35 years of experience in Barcelona. Every case needs an individual medical assessment.