What are the other Names for the Procedure?
- Stapes Removal
What is Stapedectomy surgical procedure?
- Stapedectomy is a surgical procedure that involves removal of the stapes bone (one of the 3 small bones within the middle ear)
- This procedure is predominately performed to improve hearing. It is also known as Stapes Removal procedure
What part of the Body does the Procedure involve?
Stapedectomy involves the external ear canal, eardrum, middle ear, and stapes bone.
Why is the Stapedectomy surgical procedure Performed?
A Stapedectomy is performed for the following reason:
- To improve hearing or prevent prolonged hearing loss resulting from otosclerosis (a hereditary disorder causing deafness due to overgrowth of bone in the inner ear)
- The procedure can help improve sound transmission to the inner ear
What are some Alternative Choices for the Procedure?
- A modified version of the Stapedectomy surgical procedure, called stapedotomy, is sometimes considered as an alternative method of treatment
- According to many healthcare providers, it is believed that the stapedotomy surgical procedure is safer and will decrease the chance of an individual experiencing any postsurgical complications.
What are the Recent Advances in the Procedure?
The use of a laser microsurgery is a new technique used in a Stapedectomy surgical procedure.
What is the Cost of performing the Stapedectomy surgical procedure?
The cost of Stapedectomy procedure depends on a variety of factors, such as the type of health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding a Stapedectomy procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Stapedectomy surgical procedure:
How is the Stapedectomy Performed?
The Stapedectomy procedure is performed in the following manner:
- Anesthesia, either local or general, is administered to the individual. Local anesthesia is given by an injection to the ear
- An incision is made in the eardrum and the eardrum is carefully lifted
- Using a microscope, the stapes bone is examined carefully within the inner ear
- The stapes bone (also known as stirrup) is detached from the anvil bone to which it is attached, using a laser
- In many cases, a prosthesis (an artificial device) is inserted to replace the removed stapes bone
- The eardrum is placed back into its original position
Where is the Procedure Performed?
A Stapedectomy procedure is usually performed in an out-patient surgery center facility or a hospital.
Who Performs the Procedure?
An otolaryngologist performs a Stapedectomy procedure.
How long will the Procedure take?
A Stapedectomy surgical procedure usually takes about 1 hour to perform.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Stapedectomy procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Normally local anesthesia is not used in Stapedectomy procedure; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for the Stapedectomy procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Stapedectomy surgical procedure?
Before a Stapedectomy procedure, the patient has to undergo certain tests such as:
- Routine blood and urine analysis
- Hearing tests
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Stapedectomy surgical procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Stapedectomy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
In some cases, general anesthesia by injection and inhalation is administered prior to the procedure. In other cases, local anesthesia is used. The healthcare provider will determine the best option that is suited for each case.
How much Blood will you lose, during the Procedure?
There is typically little or no blood loss involved during a Stapedectomy surgical procedure.
What are the possible Risks and Complications during the Stapedectomy surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during a Stapedectomy surgical procedure include:
- Infection within the surgical wound
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Stapedectomy surgical procedure?
- After the Stapedectomy procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
- The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
- Individuals are usually discharged from the hospital within 3-5 days of the procedure, if there are no complications
After the Stapedectomy surgical procedure:
What are the possible Risks and Complications after the Stapedectomy surgical procedure?
The possible risks and complications that may arise after Stapedectomy procedure are:
- Infection within the surgical wound
- Occasionally, the surgery may not yield the expected results
What is the Prognosis after the Surgery?
A complete recovery from Stapedectomy surgical procedure is usually achieved, without any serious complications being noted. Hearing should return almost immediately after the procedure.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling within the surgical wound
- Excessive bleeding or fluid drainage within the surgical wound
- The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, or constipation
- Continued postoperative hearing loss
- Signs of an infection
- Muscle aches, headache
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Stapedectomy surgical procedure?
At home, the following post-operative care is recommended, after a Stapedectomy surgical procedure:
- Slowly resume regular/daily activities as early as possible, which aids in faster recovery
- Avoid blowing your nose for at least 1 week after the procedure
- Protect ears from humidity or cold by wearing hearing protectors (ear muffs, etc.)
- Avoid individuals who have certain upper-respiratory infections, until complete healing has occurred
- Avoid unexpected pressure changes (such as change of altitude) or noisy environments
- Complete the course of prescribed medication under advice of the physician
- Take stool softeners to prevent constipation
- Take antibiotic medication to help combat or prevent infection
- Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain
- Avoid all activities that are physically strenuous for 6 weeks after surgery; avoid stressful situations, such as bending, lifting, or pulling heavy objects
- Resume driving 3 weeks after being discharged from the healthcare facility, or as advised by your physician
How long does it normally take to fully recover, from the Procedure?
It usually takes approximately 2-3 weeks to fully recover from the Stapes Removal procedure.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision.
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Stapedectomy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The out-patient surgery center facility or a hospital
- An anesthesiologist
- A otolaryngologist
- A pathologist (if the tissue was sent for analysis)
The patient is advised to inquire and confirm the type of billing, before the Stapedectomy is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA