For most people, the hearing improvement from a stapedectomy holds up well for many years, often a decade or longer, before any measurable decline sets in. A French study with a median follow-up of 11 years found that roughly half of patients still had normal hearing or only mild hearing difficulty at that point.1PubMed Central. Long term outcome of otosclerosis surgery A separate study tracking children and adolescents for an average of 25 years found no significant change in the air-bone gap between the two-month postoperative measurement and the final one decades later.2PubMed. Long-term follow-up of stapedectomy in children and adolescents That said, “lasting” does not mean “permanent and unchanging,” and the story of what happens to hearing in the years and decades after surgery is more layered than a simple yes-or-no durability claim.
What the Long-Term Numbers Look Like
The best way to judge how long a stapedectomy lasts is to look at studies that followed patients for years after the initial procedure. In the 11-year French study, preoperative air-conduction hearing levels averaged about 64 dB, meaning patients started with a substantial hearing deficit. Immediately after surgery, that dropped to around 36 dB, a dramatic improvement. By the late follow-up at 11 years, it had crept back up to about 44 dB, still a large net gain over the preoperative level but clearly not as sharp as the early postoperative result.1PubMed Central. Long term outcome of otosclerosis surgery Nearly half of those patients still had hearing that was normal or close to it after more than a decade.
In the pediatric study with a 25-year average follow-up, the picture was even more encouraging in terms of gap closure. About half of the ears maintained an air-bone gap within 10 dB at the final check, and another 40 percent were in the 10-to-20 dB range, meaning 90 percent of ears still had a reasonably tight closure a quarter-century later.2PubMed. Long-term follow-up of stapedectomy in children and adolescents These numbers suggest the mechanical fix itself, replacing or fenestrating the fixed stapes bone with a prosthesis, tends to remain structurally sound for a very long time. The hearing decline that does happen is often driven by something else entirely.
Why Hearing Slowly Slips Over the Years
If the prosthesis is still working, why does hearing often worsen eventually? The main culprit is the same thing that erodes hearing in everyone: age-related hearing loss. A long-term study specifically examined this question and found that the bone-conduction thresholds in stapedectomy patients deteriorated at roughly the same rate you would expect from normal aging alone.3PubMed. Stapedectomy: long-term hearing results In other words, the inner ear was aging on schedule, independent of the surgery.
On top of that, the researchers noticed something more specific to stapedectomy patients: air-conduction levels declined faster than bone-conduction levels over time, meaning a new conductive gap was gradually reopening. This recurrent conductive loss in the speech frequencies, combined with the natural inner-ear aging, produced the overall hearing deterioration seen at long follow-up.3PubMed. Stapedectomy: long-term hearing results The practical takeaway is that even when a stapedectomy “works” mechanically for decades, your hearing at year 20 will not be identical to your hearing at year 1, partly because no surgery can stop the clock on the inner ear and partly because some conductive element tends to creep back.
When the Surgery Fails Outright
Gradual decline over many years is the usual pattern, but in a minority of cases the surgery fails more decisively. The common causes include prosthesis displacement (the tiny piston shifts out of position), erosion of the incus bone where the prosthesis attaches, unrecognized fixation of other middle-ear bones, scar tissue forming in the middle ear, and new bone or fibrous tissue growing over the oval window opening.4PubMed Central. An “Uncrimped” SMart Stapes Prosthesis: A Cause of Late Hearing Deterioration in Otosclerosis Some of these problems show up relatively early, within months, while others can develop years later.
Incus erosion deserves particular attention because it involves a slow, progressive process. The prosthesis hooks around the long arm of the incus bone, and over time the constant contact and vibration can gradually thin that bone. When it erodes enough, the prosthesis loses its anchor and stops transmitting sound effectively. This can happen many years after a seemingly successful surgery and is one of the reasons a patient might notice a sudden or accelerating drop in hearing long after the initial procedure.
Another late complication worth knowing about is perilymph fistula, where fluid from the inner ear leaks through the oval window seal. Early in the history of stapedectomy, this was more common before surgeons routinely sealed the oval window with tissue grafts. It can still occur, though, and typically presents as dizziness, fluctuating hearing, or both. The tissue used to seal the oval window may undergo some thinning over time, which is one reason that graft material selection matters for long-term durability.5PubMed Central. Comparison of Short-Term Hearing Outcome in Stapedotomy Using either Vein or Fat (Adipose Tissue) as Sealing Material
Does the Surgical Technique Matter for Longevity?
Two main techniques exist: stapedectomy, which removes the entire stapes footplate, and stapedotomy, which makes a small hole in the footplate and threads a piston through it. Both achieve comparable hearing improvement immediately after surgery and over the long term, with no significant difference in hearing levels or speech understanding at late follow-up.6PubMed. Stapedectomy versus stapedotomy: comparison of results with long-term follow-up
Where a difference does appear is in risk. One long-term comparison found that stapedotomy produced better results at high frequencies and, critically, had no cases of total hearing loss in the operated ear, whereas stapedectomy carried a rate of complete deafness of about 1.7 percent.7PubMed. Long-term results after stapedectomy versus stapedotomy This is one reason stapedotomy has become the more widely favored technique today. For the person asking how long the results last, both techniques hold up similarly over time, but stapedotomy appears to carry a lower risk of the worst-case outcome.
Prosthesis Design and Its Role in Durability
The tiny prosthesis inserted during surgery is a critical factor in how well the result holds up. Different designs exist, but one that has been studied extensively for longevity is a self-crimping prosthesis made from a nickel-titanium shape-memory alloy. Data on this device showed that the excellent closure of the air-bone gap achieved at early follow-up remained remarkably stable out to 12 years. Researchers also found no evidence that the firm grip of the self-crimping hook around the incus had any harmful long-term effect on the bone.8PubMed. Long-Term Audiometric and Clinical Outcomes Following Stapedectomy With the Shape Memory Nitinol Stapes Prosthesis
This matters because one of the identified failure modes is an improperly crimped prosthesis loosening over time.4PubMed Central. An “Uncrimped” SMart Stapes Prosthesis: A Cause of Late Hearing Deterioration in Otosclerosis A prosthesis that crimps itself uniformly around the incus, rather than relying on the surgeon’s manual crimping, could reduce this particular risk. Still, even with older prosthesis designs, many patients enjoy decades of stable results, so the prosthesis type is one piece of the puzzle rather than the whole picture.
What Happens If You Need Revision Surgery
When a stapedectomy does fail, the usual next step is revision surgery. The honest picture here is sobering compared with the first operation. A systematic review found that surgical success, defined as closing the air-bone gap to 10 dB or less, was achieved in only about 53 percent of revision cases, compared with 70 to 94 percent of first-time surgeries.9PubMed Central. Audiological outcomes after revision stapes surgeries: a systematic review A large comparative study found similar results: gap closure to 10 dB or less in about 40 percent of revisions versus roughly 62 percent of primaries. The complication rate was also higher, with bone-conduction worsening of more than 10 dB occurring in about 13 percent of revisions compared with 7 percent of first-time cases.10PubMed. Outcomes in Revision Stapes Surgery
Another review put the overall success rate for revision surgery at 45 to 71 percent even in the hands of the most experienced specialists.11PubMed Central. Revision Stapes Surgery The lower success rate is not surprising. The anatomy after a first surgery is often distorted by scar tissue, the incus may be partially eroded, and the surgeon is working in a less predictable environment. Revision surgery can still improve hearing meaningfully, but the expectations should be calibrated downward. Some patients with unsuccessful revisions end up relying on hearing aids or, in more advanced cases, cochlear implants.
The Surgeon’s Experience Makes a Difference
One factor that affects both initial outcomes and long-term durability is the skill and experience of the surgeon. Research using simulation found that experienced surgeons were significantly better at targeting the fenestration accurately and caused less movement and dislodgment of the prosthesis during crimping.12PubMed. Task performance in stapedotomy: comparison between surgeons of different experience levels A well-placed prosthesis with a secure crimp is more likely to remain stable for years.
Interestingly, the learning curve for stapedotomy does not follow a straightforward pattern. An analysis of surgical learning curves found that as surgeons became more skilled, they tended to take on harder cases, such as patients with worse preoperative hearing or revision surgeries, which made their overall success statistics look less impressive even as their technical ability improved.13PubMed. A Critical Look Into Stapedotomy Learning Curve: Influence of Patient Characteristics and Different Criteria Defining Success For a patient considering surgery, the practical lesson is that choosing a surgeon who performs stapedectomies regularly is one of the most controllable factors in both short-term success and long-term durability.
Stapedectomy in Children and Younger Patients
Otosclerosis most commonly appears in young to middle-aged adults, but it can also affect children and teenagers. There has been some historical hesitancy about operating on young patients, partly because of concerns that a longer remaining lifespan means more years for the repair to potentially fail and partly because pediatric middle-ear anatomy can be more variable. The evidence, however, is reassuring. The 25-year follow-up study mentioned earlier specifically tracked patients who had surgery as children or adolescents and found no significant deterioration of the air-bone gap over that entire period.2PubMed. Long-term follow-up of stapedectomy in children and adolescents
A study of 35 ears in children found that about 57 percent achieved a very good result and an additional 29 percent had a good result at long-term follow-up, with the hearing gains remaining stable from the one-year mark onward.14JAMA Otolaryngology–Head & Neck Surgery. Stapedectomy in Children: Causes and Surgical Results in 35 Cases Pediatric patients with juvenile otosclerosis tend to respond similarly to adults, while those with congenital stapes footplate fixation, a different underlying condition, may have slightly less predictable results due to associated ossicular anomalies.15Otology & Neurotology. Outcomes Comparing Primary Pediatric Stapedectomy for Congenital Stapes Footplate Fixation and Juvenile Otosclerosis Still, when performed by an experienced surgeon, stapedectomy in younger patients holds up well over time.
Bilateral Otosclerosis and Operating on Both Ears
Otosclerosis frequently affects both ears, and some patients eventually have stapedectomy on each side, typically months or years apart. A long-term re-examination of 96 patients (192 ears) who had bilateral stapedectomy found that the air-bone gap was closed to within 10 dB in about 74 percent of ears. However, about a quarter of patients were using a hearing aid at the time of the examination, mainly because of age-related inner-ear decline rather than prosthesis failure. Serious sensorineural loss attributed to the operation was found in about 11 percent of ears.16Cambridge University Press. Long-term results of bilateral stapedectomy The decision to operate on a second ear carries additional weight because a poor outcome would affect the patient’s only remaining surgically untouched ear, and patients should be aware that even a successful bilateral result may eventually be supplemented by hearing aids as aging takes its toll on inner-ear function.
Physical Activities After Surgery
A question that comes up frequently after stapedectomy is whether the repair limits what you can do physically, particularly activities involving pressure changes like scuba diving or skydiving. A study of 28 patients who returned to scuba diving or skydiving after stapedectomy found that while some experienced minor symptoms, such as ear pain on descent or brief dizziness, no significant long-term effects pointing to inner-ear damage were seen in any of the participants. One patient did develop a perilymph fistula that required repair, though this occurred months after the dive and was attributed to noise exposure rather than the pressure change itself. Most ear surgeons still advise caution, particularly in the first few months after surgery while healing is ongoing, and some recommend against deep diving permanently. But the available evidence suggests that moderate recreational diving is not categorically ruled out for patients with well-healed stapedectomies.
When Otosclerosis Progresses Beyond What a Stapedectomy Can Address
Otosclerosis is a progressive disease in some patients. The surgery fixes the mechanical problem of a frozen stapes bone, but it does not stop the disease process itself. In a small percentage of cases, otosclerosis advances to what is called far-advanced otosclerosis, where the disease has invaded the inner ear (the cochlea) to the point of causing severe to profound sensorineural hearing loss that a stapedectomy alone cannot correct. At that stage, cochlear implantation becomes the treatment of interest.
A meta-analysis comparing cochlear implants with stapes surgery in far-advanced otosclerosis found that cochlear implants achieved a better average pure-tone result (around 29 dB versus 52 dB for stapedectomy) and a higher patient satisfaction rate, though stapes surgery did produce better scores for recognizing individual words.17PubMed Central. Comparison of the efficacy of cochlear implantation and stapes surgery in far advanced otosclerosis: a meta-analysis study Cochlear implant recipients in this population also had lower revision surgery rates (about 8 percent versus 16 percent for stapes surgery) and lower complication rates overall.17PubMed Central. Comparison of the efficacy of cochlear implantation and stapes surgery in far advanced otosclerosis: a meta-analysis study Studies tracking cochlear implant outcomes over five years in otosclerosis patients found speech comprehension scores comparable to those of non-otosclerosis implant recipients.18PubMed Central. Long‐Term Hearing Outcomes Following Cochlear Implantation in Far Advanced Otosclerosis For the minority of patients whose disease outpaces their stapedectomy, a cochlear implant represents a viable next step rather than a dead end.
Can Medication Slow the Disease and Protect Surgical Results?
Because otosclerosis is a disease of abnormal bone remodeling, researchers have explored whether medications that influence bone metabolism can slow its progression and, by extension, help preserve surgical results. The two main candidates are sodium fluoride and bisphosphonates, drugs more commonly associated with osteoporosis treatment.
A systematic review of the evidence found that sodium fluoride given for at least six months appeared to stabilize hearing thresholds, improve balance symptoms, and delay worsening of tinnitus. Bisphosphonates given for the same minimum period showed meaningful improvement in hearing loss, dizziness, and tinnitus. In double-blind studies where bisphosphonates were given for at least two years, the treated groups showed greater stabilization of both air-conduction and bone-conduction thresholds compared with placebo groups.19PubMed Central. Conservative Otosclerosis Treatment With Sodium Fluoride and Other Modern Formulations: A Systematic Review These medications are not a substitute for surgery when the stapes is fixed, but they could theoretically help prevent the disease from progressing to the inner ear after a successful stapedectomy. The evidence is still considered preliminary, and not all ear surgeons routinely prescribe these drugs, but the research so far points in a promising direction for patients concerned about long-term disease progression.