Otosclerosis and Stapes Surgery

Preoperative Assessment

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This segment discusses surgical indications, contraindications, and potential complications.


  • Conductive hearing loss
  • Audiogram
  • Tuning fork
  • Air-bone gap
  • Surgical indications
  • Potential complications

About this video

Cameron C. Wick
First online
14 March 2019
Online ISBN
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

Many of the symptoms caused by otosclerosis can also be present with other diseases. Therefore, a preoperative assessment by an otolaryngologist is critical. This segment will review the indications, contraindications, and potential complications that all must be discussed with the patient.

The main indication for surgery is a conductive hearing loss with an air-bone gap of at least 15 decibels. The standard audiogram should be confirmed with your tuning fork exam. Specifically, the Weber should lateralize to the affected ear. While the Rinne testing should show bone conduction greater than air conduction.

It is also advised that audiograms contain a tympanogram and acoustic reflexes. The absence of acoustic reflexes can help support that the ossicular chain is fixed.

Radiographic imaging is not necessary for all cases. However, if there is concern for other diseases that may be causing the conductive hearing loss, or in adolescent males which may be more prone towards genetic causes of conductive hearing loss, a CT scan is strongly considered.

Additional indications include operating on the poor hearing ear. The patient must have reasonable health to tolerate surgery. And the patient should have appropriate expectations for the surgical intervention, as well as awareness of all the treatment modalities.

Contraindications for surgery include an inadequate air-bone gap, poor overall health, active balance issues, particularly Meniere’s disease, tympanic membrane pathology, such as a tympanic membrane perforation; or if there is active external or middle ear disease.

It is important to discuss all potential complications with the patient. Thankfully, serious complications are rare. Overall complications may include taste change, dizziness, tympanic membrane perforation, hearing loss, which has the potential for profound sensory neuronal loss, and facial nerve injury.