The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Otosclerosis: Detailed Surgical Management

Stapedectomy and stapedotomy techniques: indications, prosthesis selection, and outcomes

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our KBB (Kulak Burun Boğaz) department. Book Appointment →

What is Otosclerosis: Detailed Surgical Management?

Otosclerosis is a primary disease of the otic capsule (bony labyrinth) characterized by abnormal bone remodeling — replacement of normal endochondral bone with spongy vascular bone (otospongiosis), then sclerotic bone. The fissula ante fenestram (anterior to the oval window) is the most common focus, leading to stapes footplate fixation and conductive hearing loss.

Surgical options: stapedotomy (small fenestra in footplate, prosthesis through hole) is preferred today over stapedectomy (footplate removal). Prosthesis types: piston prosthesis (fluoroplastic, titanium, platinum-band), lengths 4.0-4.5 mm, diameter 0.4-0.6 mm. Laser-assisted stapedotomy (CO2, KTP, argon) reduces footplate trauma and improves outcomes.

Outcomes: air-bone gap closure to <10 dB in 90-95%, sensorineural hearing loss <1%, dead ear <1%. Indications: conductive/mixed loss with air-bone gap >25 dB, normal tympanic membrane, present Carhart notch (2 kHz), good speech discrimination. Contraindications: only-hearing ear, active Ménière's, far-advanced otosclerosis (consider cochlear implant).

Symptoms

Progressive bilateral conductive hearing loss (often asymmetric)
Tinnitus (low-pitched, often improves post-op)
Paracusis Willisii (better hearing in noisy environments)
Schwartze sign (reddish promontory through tympanic membrane - active otospongiosis)
Vertigo (rare, post-op transient)
Speech discrimination preserved early, declines in mixed phase

Risk Factors

Family history of otosclerosis (autosomal dominant, 25-50% penetrance)
Female gender (2:1 ratio)
Pregnancy (accelerates progression)
Caucasian ethnicity (highest prevalence)
Age 20-40 at onset
Measles virus exposure (controversial association)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Progressive hearing loss in young-middle-aged adult without ear infection
  • Family history with developing hearing problems
  • Hearing loss accelerating during pregnancy
  • Tinnitus accompanying hearing loss
  • Audiometry showing Carhart notch (2 kHz dip in bone conduction)
  • Air-bone gap >25 dB on audiogram (surgical candidacy)

Treatment Methods

01
Stapedotomy (small fenestra technique) - gold standard surgical option
02
Stapedectomy (footplate removal) - alternative for select cases
03
Laser-assisted stapedotomy (CO2/KTP) - reduces footplate trauma
04
Prosthesis selection (titanium/fluoroplastic piston, 4.0-4.5 mm × 0.4-0.6 mm)
05
Hearing aids (alternative for non-surgical candidates)
06
Sodium fluoride therapy (50 mg/day - controversial, slows progression)
07
Cochlear implantation (far-advanced otosclerosis with profound SNHL)
08
Bisphosphonates (experimental - active otospongiosis)
09
Annual audiometry follow-up post-surgery

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About KBB (Kulak Burun Boğaz) Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.