Best Hospitals for Stapedectomy Surgery in Chennai, India

Otosclerosis is an abnormal remodeling disorder of the bony labyrinth in which spongy vascular bone progressively encases the footplate of the stapes, the smallest and innermost of the three ossicular bones. As the footplate becomes fixed, it can no longer transmit sound-pressure waves efficiently from the tympanic membrane into the perilymph-filled cochlea, producing a characteristic low-frequency conductive hearing loss that, if untreated, may advance to mixed or sensorineural loss as cochlear endosteum becomes involved. The condition is autosomal-dominant with variable penetrance, affects women roughly twice as often as men, and often manifests or accelerates during pregnancy due to estrogen-mediated osteoclast activation. Audiometric hallmarks include Carhart's notch (a dip near 2 kHz on bone-conduction audiometry), an absent acoustic stapedial reflex, and a type As (shallow) tympanogram.

• Confirmed otosclerosis on pure-tone audiometry showing a conductive or mixed hearing loss with an air-bone gap ≥ 20–25 dB HL at two or more frequencies
• Absent or significantly reduced acoustic stapedial reflex on impedance audiometry (tympanometry type As pattern)
• High-resolution CT of the temporal bones demonstrating anterior focus of otosclerosis (halo sign around the cochlea or stapes footplate fixation) and ruling out superior semicircular canal dehiscence or other mimics
• Adequate sensorineural reserve: speech discrimination score ≥ 60% on word recognition testing to justify operative risk to residual cochlear function
• Failure of, or patient preference over, conventional amplification (hearing aids)
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Required Pre-operative Diagnostics:

• Pure-tone audiogram (PTA) and speech audiogram (SDS/SRT) — mandatory
• Tympanometry and acoustic reflex testing
• High-resolution CT temporal bones (0.5–1 mm axial and coronal reconstructions)
• MRI internal auditory canal if retrocochlear pathology must be excluded
• Baseline blood panel: CBC, coagulation profile (PT/INR, aPTT), metabolic panel, HbA1c (if diabetic)
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1. CONVENTIONAL STAPEDECTOMY (Total Footplate Removal)

The historical gold-standard approach involves complete removal of the stapes arch and entire footplate under operating microscope magnification (×10–×40). A vein graft or absorbable gelatin-sponge seal is placed over the oval window, and a stainless-steel, Teflon-platinum, or titanium piston prosthesis (0.4–0.6 mm diameter, 4–4.75 mm length) is crimped to the long process of the incus. This technique is preferred in cases of obliterative footplates or thick bony fixation where small-fenestra techniques are less feasible.

2. SMALL-FENESTRA STAPEDOTOMY (Current Preferred Standard)

Rather than full footplate removal, a precisely calibrated fenestra (0.4–0.8 mm) is drilled or lasered into the footplate center. This minimizes perilymph displacement, reduces risk of sensorineural hearing loss, and allows more predictable prosthesis seating. The piston is crimped to the incus lenticular process. Stapedotomy has largely replaced total stapedectomy in high-volume centers due to superior safety profile.

PRE-OPERATIVE PHASE (Weeks –4 to –1):

• Week –4: GAF Healthcare coordinator receives patient's audiogram, CT temporal bone report, and medical records. Remote review by the assigned otologist/otolaryngologist at the partner hospital is arranged.
• Week –3 to –2: Virtual consultation with the surgeon. Prosthesis type, laterality (which ear first if bilateral), and surgical approach (microscopic vs. endoscopic, laser vs. drill) are confirmed. Patient instructed to discontinue aspirin/NSAIDs/anticoagulants 7–10 days pre-op per anesthesia protocol.
• Week –1: Arrival in India or UAE. GAF Healthcare airport transfer arranged. Pre-admission workup completed: repeat PTA, tympanometry, blood panel, anesthesia fitness assessment, and temporal bone CT review by the operating surgeon.
• Day –1: Hospital admission. Informed consent, surgical site marking, anesthesia pre-assessment. Patient is kept nil-by-mouth from midnight.

INTRAOPERATIVE PHASE (Day 0 — Approximately 60–120 minutes):