What is otosclerosis?
Otosclerosis is a condition affecting the bone that surrounds the inner ear. Abnormal bone forms around the stapes, the last of the three ossicles in the middle ear. Little by little this bone stops the stapes moving. Sound then no longer reaches the inner ear properly.
This leads to progressive conductive hearing loss, meaning reduced hearing that slowly worsens over time. It often starts between the ages of 20 and 40 and can affect both ears. It is sometimes accompanied by tinnitus, a ringing or buzzing in the ear. It is not unusual for other family members to have the same problem.
What is stapedectomy and how does the micro-prosthesis work?
Stapedectomy is the operation that replaces the fixed stapes with a micro-prosthesis. This is a tiny piston that takes over its role. The prosthesis is attached to the incus, the ossicle just before the stapes, and once again carries sound vibrations to the inner ear.
Today a variant called stapedotomy is often performed. Instead of removing the whole stapes, a very small hole is made in its base, called the footplate, and the prosthesis is inserted into it. The hole can be made with dedicated micro-instruments or with a laser. The most suitable technique is explained at the consultation.
When is stapedectomy needed, and what are the alternatives?
The most common signs of otosclerosis are difficulty following conversations, needing to turn up the TV and, sometimes, tinnitus. However, these symptoms can have many causes. An ENT consultation is needed to find out where the hearing loss comes from.
Surgery is not the only option. For many people with otosclerosis, a hearing aid is a valid alternative that amplifies sounds without surgery. The advantages and limitations of both options are discussed at the consultation, based on the hearing test and the patient's preferences.
Stapedectomy is generally considered when:
- tests confirm conductive hearing loss caused by fixation of the stapes;
- hearing loss affects daily life or work;
- the eardrum is intact and the ear has no active infection;
- the patient, informed about the alternatives, prefers surgery.
How do you prepare? The consultation and tests before surgery
Assessment begins with an ENT consultation. The eardrum is examined with an otomicroscope, an instrument that magnifies the view of the ear. A hearing test (audiometry) measures how well you hear, and shows whether the hearing loss is conductive.
Tympanometry (impedance testing) is a quick, painless test. It checks how the eardrum moves and the stapedial reflex, the contraction of a small muscle attached to the stapes. In otosclerosis this reflex usually cannot be recorded. In some cases a CT scan of the ear is also useful, alongside routine pre-operative tests.
Consultations take place at the practice in Via Niccolò dall'Arca 19, Bari, near Bari Centrale station. Appointments can be booked online on MioDottore or by phone on 080 5219334.
How is stapedectomy performed and how long is the hospital stay?
The operation is performed with an operating microscope, usually through the ear canal, so there are no visible external cuts. The surgeon gently lifts the eardrum, reaches the stapes and positions the micro-prosthesis. At the end, the eardrum is put back in place and a dressing is placed in the ear canal.
The operation can be done under general or local anaesthesia, depending on the case. It generally takes one to two hours. The hospital stay is usually short, generally one or two nights. Dr De Candia gives personalised advice after the consultation.
What is recovery like after stapedectomy?
In the first few days you may feel mild dizziness or unsteadiness, which usually settles quickly. At first, hearing is muffled because of the dressing in the ear canal. For this reason the result is assessed with a hearing test after healing, roughly one to two months later.
People with desk jobs usually return to work after 1–2 weeks. Scuba diving is often discouraged even in the long term. These timescales are a guide and vary from person to person.
During the first few weeks you will generally be advised to:
- keep the ear dry, protecting it from water in the shower and when washing your hair;
- avoid blowing your nose hard, and sneeze with your mouth open;
- avoid flying until the doctor gives the go-ahead;
- avoid strenuous effort, heavy lifting and sudden head movements;
- not drive while you feel dizzy.
What are the risks of stapedectomy?
Like any operation, stapedectomy carries possible risks and complications. They are generally uncommon. They are discussed in detail at the pre-operative consultation, together with informed consent. They include:
- dizziness or unsteadiness, usually temporary;
- tinnitus, a ringing or buzzing in the ear;
- altered taste on one side of the tongue, often temporary;
- hearing not improving, or the prosthesis shifting over time, which may require further surgery;
- rarely, a permanent worsening of hearing in the operated ear, which can amount to deafness;
- very rarely, an eardrum perforation or injury to the facial nerve, which moves the muscles of the face.
Why choose an ENT specialist for stapedectomy in Bari?
Stapes surgery is carried out on structures a few millimetres in size. It requires familiarity with the operating microscope and a sound understanding of hearing. Dr Nicola De Candia has been a specialist in Otorhinolaryngology since 1991. He holds a PhD in the Pathophysiology of Audio-Verbal Communication from the University of Naples Federico II.
In 1993 he took part in the “Visiting Physician's program” at the House Ear Institute in Los Angeles. This is a US centre for research into the ear and hearing. He is also a specialist in Neurosurgery. Over his career he has performed more than 1,000 operations in total.
Every decision is shared with the patient after the consultation. This includes the choice between surgery and a hearing aid.
The information on this page is for general education and does not replace a specialist consultation: indications, recovery times and risks are assessed case by case.