Stapendectomy

Stapedectomy is the surgical procedure to remove the stapes bone and to replace it with a prosthetic stapes.  This procedure can be done under either general anesthesia or local anesthesia with IV (intravenous) sedation.  The procedure is usually performed through the ear canal, although occasionally an incision must be made behind the ear in patients with narrow (<4.5 mm) ear canals.  Procedure is performed with the use of an operative microscope.  A facial nerve monitor is used to follow facial nerve function during the procedure.

Steps to the procedure (or see a PowerPoint presentation of steps):

1. Local anesthetic is injected into the ear canal

2. The patient is sterilely prepped and draped.

3. An incision is made in the ear canal, and the ear canal skin and eardrum (a tympanomeatal flap) are elevated.

4. The exposed posterior-superior ear canal bone is then removed with fine curettes to expose the ossicular chain and the stapedius tendon.

5. The ossicles are challenged to determine which bone(s) is (are) not moving.

6. If the stapes alone is immobile, stapedectomy continues by measuring the distance between the stapes footplate and the lateral surface of the incus.  An additional 0.25 mm is added to this measurement to allow for the thickness of the stapes footplate.

7. A control hole is made in the stapes footplate with either a fine pick or the argon laser.

8. The incudostapedial joint is then severed.  The movement of the malleus and incus are once again checked.

9. The stapedial tendon is then divided and the stapes superstructure is down-fractured and removed.

10. The stapes footplate is then either partially or totally removed using fine right-angle hooks.

11. A graft of soft tissue (either fat, fascia, or vein) is placed over the open oval window.

12. The stapes prosthesis is then placed between the oval window graft and the incus.  If a piston-type prosthesis is used, its hook is crimped onto the incus.  If a bucket-type prosthesis is used, its bucket handle is placed over the incus.

13. The movement of the ossicular chain is then checked.

14. The tympanomeatal flap (ear canal skin and eardrum) is then placed back into its normal position, and the ear canal is packed.

Patients are then monitored for several hours after their procedure and are permitted to go home once they meet certain criteria.

Postoperative Care Instructions for Stapedectomy

1.      Keep all water out of operated ear.  When showering, bathing, or washing hair, place some Vaseline on cotton ball and insert into ear canal.  When finished washing or bathing, remove cotton ball and wipe ear dry.

2.      Do not blow your nose or lift objects heavier than 10 pounds.

3.      If you need to sneeze, keep your mouth wide open to avoid exerting excessive pressure in the back of the nose.

4.      Avoid strenuous activities.  You may continue most other regular activities.

5.      Keep head elevated on 2 or more pillows when in bed.

6.      If antibiotic ear drops have been prescribed, place 5 drops in the ear two times a day until your physician directs you to stop.

7.      If there are stitches behind the ear, clean the stitches with hydrogen peroxide; and then apply the antibiotic ointment to the area twice a day until your physician directs you to stop.  If there is surgical tape (Steri-Strips) covering the wound, leave the tape alone and do not use hydrogen peroxide.  Two weeks after your surgery, the tapes can be removed by pulling from the top of the tape downward.

8.      Any cotton in the ear can be replaced as needed.  Blood-stained drainage from the ear is normal after ear surgery.  Once the ear drainage subsides, use of the cotton can be discontinued.  Do not remove anything else from inside the ear canal.

9.      For ear pain, use Tylenol as directed or prescription medication as directed.  The pain is usually not severe and will subside in a few days.

10.  Call the office for purulent drainage, severe dizziness, fever above 101.5 F, or facial weakness.