Replacement of the stapes ossicle with a prosthesis following removal of the stapes arch and making an opening in the stapes footplate. Alternatively, the footplate may be removed completely. In this case, the procedure is called a stapedectomy.

The main indication is otosclerosis surgery. However, this procedure is also used in tympanosclerosis and chronic otitis media surgery.

The tympanomeatal flap has been elevated and the lesser tympanic spine, chorda tympani, and short process of malleus have been exposed. During the operation, there is no need to expose the inferior part of the tympanic cavity too extensively.

II: Micro elevator

MIL: Tympanic annulus

CT: Chorda tympani

SPM: Short process of malleus

STMI: Spina tympanica minor

TA: Tympanic annulus

TMF: Tympanomeatal flap

Using a small curette or small diamond burr, a “stapedotomy drilling” is carried out in the area of the lesser tympanic spine. A common mistake is drilling too anteriorly and thus exposing the body of the incus. This is called partial atticotomy and has no place in a stapedotomy procedure.

II: Small curette

MIL: Lesser tympanic spine

Under higher magnification, the critical structures are observed. During “stapedotomy drilling” the chorda tympani is easily damaged accidentally. To prevent this, the direction of drilling or maneuvering of the curette should be away from the chorda tympani.

LPI: Long process of incus

P: Promontory

PP: Pyramidal process

RW: Round window

SH: Stapes head