A stapedectomy is a surgical procedure that removes a small, frozen bone deep inside the ear and replaces it with a tiny prosthesis to restore hearing. It treats a condition called otosclerosis, where abnormal bone growth locks the stapes (the smallest bone in your body) in place, preventing it from vibrating and transmitting sound. The surgery has a long track record of success, with most patients experiencing significant hearing improvement that lasts well over a decade.
Why the Stapes Bone Matters
Sound travels through your ear canal, vibrates your eardrum, and then passes through a chain of three tiny bones in the middle ear. The stapes is the last bone in that chain. It sits against a membrane called the oval window, and when it vibrates, it pushes sound energy into the fluid-filled inner ear, where your brain can process it as hearing.
In otosclerosis, the normal dense bone surrounding the inner ear is slowly absorbed and replaced with softer, spongy bone. This abnormal bone growth gradually locks the stapes footplate in place. When the stapes can no longer vibrate freely, sound can’t reach the inner ear efficiently. The result is a progressive, often frustrating hearing loss that typically affects both ears, though one side usually worsens first. Otosclerosis is the most common reason for this type of conductive hearing loss in adults.
Stapedectomy vs. Stapedotomy
You’ll often see these two terms used interchangeably, but they describe slightly different approaches. In a stapedectomy, the surgeon removes nearly the entire stapes footplate, leaving only about 25% of it to support the prosthesis. In a stapedotomy, the surgeon leaves the footplate mostly intact and drills or lasers a small hole through it, just large enough to fit a piston-shaped prosthesis.
Stapedotomy has largely replaced stapedectomy as the preferred technique. Most ear surgeons favor it because it tends to produce better hearing results, more stable long-term outcomes, and lower rates of complications like inner ear hearing loss, dizziness, and fluid leakage. In one study, 88% of stapedotomy patients achieved near-complete closure of their hearing gap compared to 64% with stapedectomy. That said, surgeons sometimes convert to a stapedectomy during the operation if the footplate cracks or comes out with the rest of the bone.
What Happens During Surgery
The procedure is performed through the ear canal, so there are no external incisions or visible scars. The surgeon lifts the eardrum forward to access the middle ear bones, confirms that the stapes is indeed fixed in place, and then carefully separates and removes the upper portion of the stapes. Depending on the technique, the footplate is either removed or fenestrated (a small hole is made in it). A prosthesis, typically a piston a fraction of a millimeter wide, is then hooked onto the neighboring bone (the incus) and inserted into or onto the oval window opening. A small piece of tissue seals around the prosthesis to protect the inner ear.
The prosthesis itself is usually made from Teflon (fluoroplastic) or titanium. Teflon pistons are the most commonly used worldwide. Titanium versions feature a clip design that some surgeons find easier to attach, and they may perform slightly better with very small fenestra openings. Overall, published comparisons show no significant difference in hearing outcomes between the two materials.
Local or General Anesthesia
Stapes surgery can be done under either local or general anesthesia, and the hearing results are the same regardless of which you receive. Local anesthesia shortens both the procedure and total operating room time by roughly 9 to 17 minutes. One potential advantage of local anesthesia is that patients can report what they hear during the surgery, giving the surgeon real-time feedback. General anesthesia may be slightly more likely to cause postoperative nausea and vomiting, though the difference is small. Your surgeon will help decide which option makes sense based on your comfort level and medical history.
Recovery Timeline
Most of the procedure is outpatient, meaning you go home the same day. Packing material inside the ear canal is typically removed at a follow-up visit within one to two weeks. You can expect some muffled hearing until the packing comes out, after which hearing often improves noticeably.
Dizziness is the most common short-term side effect. Up to 82% of patients experience some degree of vertigo, but for most people it is mild and resolves within 48 hours. A smaller group, roughly 15%, may have more significant dizziness lasting a week or longer. During recovery, you’ll be advised to avoid heavy lifting, straining, and nose blowing, all of which can increase pressure in the ear.
Flying restrictions depend on which procedure you had. After a stapedotomy, there is no required waiting period as long as your eustachian tube is functioning normally. After a stapedectomy, the recommendation is to wait at least two weeks before flying, giving the tissue seal over the oval window enough time to heal. Whenever you do fly after stapes surgery, performing a gentle Valsalva maneuver (pinching your nose and gently blowing to equalize pressure) about every four minutes during descent helps protect the prosthesis.
Success Rates and What to Expect
Stapes surgery is one of the more predictable operations in ear surgery. Success is measured by how well it closes the “air-bone gap,” which is the difference between what your inner ear can hear and what actually reaches it through the middle ear. Closing that gap to within 10 decibels is considered a successful result. With stapedotomy, about 88% of patients achieve this benchmark. With stapedectomy, roughly 64% reach full closure, and an additional 16% get to within 20 decibels.
For many patients, the improvement is dramatic. Preoperative hearing thresholds averaging around 64 decibels (moderate to moderately severe hearing loss) typically improve to about 36 decibels (mild hearing loss) shortly after surgery. That’s roughly the difference between struggling to follow a conversation and hearing comfortably in most situations.
How Long Results Last
Hearing improvements from stapes surgery are durable but not permanent in every case. In a study with a median follow-up of 11 years, hearing thresholds did worsen somewhat over time compared to the initial postoperative result, but they remained significantly better than before surgery. At the 11-year mark, 49% of patients still had normal hearing or only mild hearing loss.
Notably, patients who had surgery on one ear and left the other untreated showed that the operated ear was still hearing significantly better than the unoperated ear 11 years later. This suggests the surgery provides a meaningful, lasting advantage even as some gradual decline occurs, likely from the natural progression of otosclerosis or age-related changes in the inner ear.
Risks and Complications
The most serious risk is damage to the inner ear, which can cause permanent sensorineural hearing loss, the type that a hearing aid or prosthesis cannot fully correct. Profound hearing loss (essentially losing all useful hearing in that ear) occurs in about 1% of stapedotomy cases. Less severe inner ear hearing loss happens in 3% to 10% of cases, depending on the study and technique used.
Taste disturbance is another common side effect. The chorda tympani nerve, which carries taste sensation from the front two-thirds of the tongue, runs directly through the middle ear space. Any manipulation of this nerve during surgery can cause a metallic or altered taste on one side of the tongue. For most patients this fades over weeks to months, though it occasionally persists.
Revision surgery is needed in roughly 5% to 10% of cases over a patient’s lifetime. Reasons include prosthesis displacement, ongoing otosclerosis affecting the new opening, or scar tissue formation around the prosthesis. Tinnitus (ringing in the ear) can develop or worsen after surgery in a small percentage of patients, and rarely, a perilymphatic fistula (a leak of inner ear fluid) can occur, requiring additional treatment.