Stapedectomy surgery

A stapedectomy surgery is a specialized microsurgical procedure performed to restore hearing in patients with otosclerosis. The surgery involves removing the fixed stapes and replacing it with a prosthetic device that allows sound vibrations to be transmitted effectively to the inner ear.

This operation is considered one of the most effective treatments for conductive hearing loss caused by stapes fixation. Unlike hearing aids, which amplify sound, a stapedectomy addresses the underlying mechanical problem of sound transmission. From an otologic standpoint, stapedectomy requires high surgical precision due to the delicate anatomy of the middle ear, particularly the proximity to the facial nerve and inner ear structures. 

The surgery begins with local or general stapedectomy anesthesia to ensure patient comfort and immobility. The surgeon gains access to the middle ear through the ear canal, often using a surgical microscope for precise visualization.

Key surgical steps include:

• Elevation of the tympanomeatal flap to expose the middle ear structures.
• Identification and careful preservation of the facial nerve and chorda tympani nerve.
• Removal or perforation of the stapes footplate, depending on whether a traditional stapedectomy or stapedotomy is performed.
• Insertion of a prosthetic device (typically Teflon or titanium) to bridge the incus to the oval window.
• Repositioning of the tympanomeatal flap and closure of the canal.

Common instrument set used during the procedure include micro picks, micro scissors, delicate forceps, perforators, and prosthesis introducers, all designed for high precision in the confined middle ear space. Postoperative care involves monitoring for proper prosthesis placement and ensuring no immediate complications arise.

The results of stapedectomy surgery are generally long-lasting, with most patients experiencing stable hearing improvement for 10–20 years or more. Success largely depends on proper prosthesis placement, patient adherence to postoperative care, and the absence of progressive cochlear otosclerosis. While rare, some patients may experience gradual hearing decline over time due to prosthesis displacement, inner ear changes, or continued bone growth. Regular audiometric follow-up is recommended to monitor hearing stability and detect any issues early. With careful surgical technique and proper post-operative management, stapedectomy can provide durable restoration of conductive hearing and significantly improve quality of life.

In medical billing and coding, stapedectomy surgery is classified under the Current Procedural Terminology (CPT) system to standardize reporting and insurance reimbursement. The primary CPT code for stapedectomy is 69680, which covers the removal of the stapes and insertion of a prosthesis. Proper coding is essential for insurance claims, documentation, and hospital record-keeping. Additional codes may be used to report bilateral procedures, revisions, or the use of laser-assisted techniques, depending on the surgical approach. Accurate use of the stapedectomy CPT code ensures appropriate coverage and reduces the risk of claim denials.

Hearing improvement after stapedectomy surgery typically begins within the first few weeks, but full recovery may take several weeks to a few months. Initially, patients may notice subtle changes in hearing as the middle ear structures adapt and mild swelling or fluid resolves. Most patients experience significant improvement by 4–6 weeks, with maximum auditory benefit often achieved by 3 months post-surgery.

Regular audiometric follow-up is important to monitor progress and ensure proper prosthesis function. While most patients regain substantial hearing, results can vary depending on preoperative hearing levels and the presence of any underlying cochlear involvement.