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Stapedotomy recovery

The weeks after stapedotomy follow a fairly predictable pattern: a blocked ear and some unsteadiness at first, then hearing that opens up over weeks and settles over months. This is a general guide; the instructions for your own operation come first.

Before the timeline

This page follows the weeks after stapedotomy, the operation for otosclerosis. The pattern is broadly the same after stapedectomy, the older operation that removes more of the footplate (see stapedectomy or stapedotomy). General advice for any ear operation is on recovery after ear surgery; this page covers what is specific to stapes surgery.

Timings vary between surgeons and hospitals, and for most of them there is no agreed standard: a survey of American otologists found no consensus on when to allow flying, snorkelling or diving. The ranges below are typical, not rules. The page also gives the practice at the Clinique Causse in Colombiers, where the author practises; it is more cautious than many centres. Where your surgeon’s instructions differ, follow theirs.

Why the first weeks are cautious

The prosthesis is a small piston that passes through an opening of 0.4–0.7 mm into the fluid of the inner ear. At first that opening is closed only by a seal of blood or tissue, which firms up over two to three weeks. Pressure changes move the piston, by up to half a millimetre in laboratory measurements, so a sudden surge such as a forceful nose-blow or a sneeze with the mouth closed could disturb the seal or the prosthesis. Almost every early restriction exists to protect that seal while it heals.

Day of surgery

The operation is done through the ear canal, under general anaesthesia in most centres, and takes under an hour. Many centres send you home the same day or after one night; in a national survey of UK otologists, the two were about equally common. At the Clinique Causse, patients stay longer, up to a week.

Normal: packing in the ear canal with cotton wool at the opening; a blocked, muffled ear; some unsteadiness or nausea when you first get up; a metallic or altered taste.

Avoid: driving (arrange to be taken home), bending, lifting and getting up quickly.

The first days

Normal: a blocked ear with popping and crackling; a little blood-stained discharge; mild pain that paracetamol controls; unsteadiness on sudden head movements; louder tinnitus, often a hiss; a taste change or numbness on one side of the tongue.

Avoid: nose-blowing (sneeze with your mouth open), straining on the toilet (a mild laxative can help), lifting, bending with the head down, and water in the ear. Sleep with your head raised if that is comfortable. Put nothing in the operated ear, including a hearing aid.

Week 1

Unsteadiness is common and usually short-lived. In one prospective study, 82% of patients had some balance symptoms; all but one were free of them within the first week, and balance tests were back to normal within a month. Taste change affected about a third of patients at one week in a series of 320.

Hearing is still muffled and may fluctuate. Hearing tests in the first days often show temporary dips, even in inner-ear thresholds, which did not affect the final result in one series.

Gentle walking is fine. Avoid exercise, lifting, flying, loud noise and swimming. Drive only once the period after the anaesthetic has passed and you can turn your head quickly without feeling unsteady.

Weeks 2–3

The packing is removed at the first visit, often at one to three weeks, or dissolves. As the ear clears, many people notice a real improvement. Sounds may seem loud or tinny at first, and chewing and your own voice unusually loud; this settles.

Desk work is usually possible from one to two weeks. Keep the ear dry, and keep avoiding forceful nose-blowing, heavy lifting, strenuous exercise and contact sport. Do not fly yet. Advice on flying ranges from two weeks to two months: a national survey of UK otologists reported six weeks as the usual advice, and at the Clinique Causse the advice is two months. Ask before booking; see flying after ear surgery.

Weeks 4–6

For most people, daily life is back to normal. Many surgeons lift most restrictions now: flying, the gym, heavier lifting, and swimming once the eardrum has healed (no diving in or swimming underwater at first), with contact sport, heading a ball and martial arts from six weeks or later. At the Clinique Causse, flying and sport wait until two months, provided recovery has been uncomplicated; after a complication the timing is decided individually. Scuba diving needs a specific discussion; after stapedotomy many surgeons advise against it permanently.

In the series of 320 patients, fewer than one in ten still had a taste change at six weeks. Protect the operated ear from very loud noise, such as power tools, shooting or concerts; many surgeons advise this for life.

Months 2–3

Hearing continues to settle and may still improve. Many surgeons arrange a first hearing test around now. At two months, after an uncomplicated recovery, the Clinique Causse advice allows flying and sport again. Taste has recovered in most people: about 1% still had a change at one year in the large series, although a Danish series of 93 operations reported a lasting change in 14%.

The audiogram at three to six months

This test measures the result. The aim is an air-bone gap of 10 dB or less, reached in roughly 80–90% of first operations, with the inner-ear (bone-conduction) thresholds unchanged. If the inner ear was already affected (a mixed loss), a hearing aid may still help afterwards.

If both ears are affected, the second is considered only once the first result is stable, typically after six months to a year; see bilateral otosclerosis. A result that was never good, or that fades, is approached as described under revision ear surgery.

When hearing usually becomes clear

Blocked for one to two weeks; often clearly better within a few weeks of the packing coming out; still changing for two to three months; judged at three to six months. An early disappointment is not a verdict on the operation.

Returning to work

  • At the Clinique Causse: usually one week off work, sometimes more depending on the job.
  • Desk or home-based work elsewhere: often after one to two weeks, sooner from home if you feel well.
  • Work that depends on hearing (telephone, teaching): plan around a blocked ear for the first weeks.
  • Physical work and heavy lifting: often three to four weeks, sometimes longer.
  • Noisy workplaces: when your surgeon agrees, with hearing protection.
  • Heights, driving for a living, machinery: not until any unsteadiness has completely gone.
  • Pilots, cabin crew, divers, wind and brass players: discuss specifically with your surgeon.

Warning signs that need same-day review

Symptoms after stapedotomy explains what is expected. Seek care the same day for:

  • Severe or spinning vertigo with vomiting, or a sudden drop or complete loss of hearing in the operated ear. After stapes surgery this may mean a leak of inner-ear fluid, and early treatment matters.
  • Facial weakness on the operated side. Weakness in the first hours can come from the local anaesthetic and wear off; weakness that appears later needs prompt assessment. Rarely (about 1 in 200 in one large series) it appears five to sixteen days after stapes surgery.
  • Severe headache, neck stiffness, high fever, drowsiness or confusion.
  • Heavy bleeding that does not stop with gentle pressure, or swelling behind the ear with pain and redness.

Call within a day or two for increasing or smelly discharge, increasing pain, fever, hearing that slips back gradually over several days after it had begun to improve, dizziness beyond the first days or set off by loud sound or pressure, or loud new tinnitus. If you cannot reach your surgeon, go to an emergency department and say what operation you had and when. The full list is on when to contact your surgeon.

Evidence behind the restrictions

These restrictions rest on physiology and caution, not trials. Among over 200 surveyed American otologists there was no consensus, and reported barotrauma did not differ by the restriction advised. A piston not attached to the annular ligament moves up to 0.5 mm in the vestibule with ambient pressure changes, so a short piston can lift out of the fenestra (for example after sneezing) and an over-long one can impinge on the membranous labyrinth. Delayed facial palsy occurred in 0.51% of 2152 stapedectomies, at 5–16 days, with serology suggesting herpesvirus reactivation. Division of the stapedius tendon removes the acoustic reflex on the operated side, the usual rationale for noise protection.

Sources

  • Harrill WC, Jenkins HA, Coker NJ. Barotrauma after stapes surgery: a survey of recommended restrictions and clinical experiences. Am J Otol. 1996;17(6):835-45. PubMed
  • Hüttenbrink KB. Biomechanics of stapesplasty: a review. Otol Neurotol. 2003;24(4):548-57. PubMed
  • Lancer H, Manickavasagam J, Zaman A, Lancer J. Stapes surgery: a National Survey of British Otologists. Eur Arch Otorhinolaryngol. 2016;273(2):371-9. PubMed
  • Ozmen AO, Aksoy S, Ozmen S, et al. Balance after stapedotomy: analysis of balance with computerized dynamic posturography. Clin Otolaryngol. 2009;34(3):212-7. PubMed
  • Sperling NM, Sury K, Gordon J, Cox S. Early postoperative results in stapedectomy. Otolaryngol Head Neck Surg. 2013;149(6):918-23. PubMed
  • Saki N, Nikakhlagh S, Kardooni M, et al. Prevalence and recovery of taste dysfunction after stapedectomy in otosclerosis: a clinical study of 320 patients. J Laryngol Otol. 2026;140(9):973-976. PubMed
  • Wedel C, Holm NH, Mirz F, Ovesen T. Otosclerosis and stapedotomy: hearing improvement, complications, and analysis of potential prognostic factors in a series of 93 cases. Acta Otolaryngol. 2023;143(7):563-569. PubMed
  • Shea JJ Jr, Ge X. Delayed facial palsy after stapedectomy. Otol Neurotol. 2001;22(4):465-70. PubMed

Common questions

How long is the recovery after stapedotomy?

Most people feel themselves again within one to two weeks and are back to most daily activities within a few weeks; flying and sport wait longer, two months in the author's practice. The ear itself takes longer: hearing keeps changing for two to three months, and the definitive hearing test is at three to six months. Timings vary between surgeons and between people, so the instructions given for your own operation take precedence over any general guide.

When will my hearing improve after stapedotomy?

The operated ear usually feels blocked for one to two weeks while packing and blood clear. Many people notice a clear improvement within a few weeks of the packing coming out, often with sounds seeming loud or tinny at first. Hearing can fluctuate during this time, and an early dip does not mean the operation has failed. The result is judged on the audiogram at three to six months.

How long after stapedotomy can I fly?

Advice varies from two weeks to two months, and there is no agreed standard. At the Clinique Causse in Colombiers, where the author practises, the advice is no flying for two months. Many other surgeons allow it after two to six weeks, once the opening into the inner ear has sealed and any dizziness has settled. Ask before booking. Avoid flying with a cold, and do not force air into your ears on descent unless your surgeon has said you may. See the page on flying after ear surgery.

When can I go back to work after stapedotomy?

At the Clinique Causse the usual advice is one week off work, sometimes more depending on the job. Elsewhere, desk work often resumes after one to two weeks; physical work and heavy lifting usually need three to four weeks, sometimes longer. Work at heights, driving for a living or operating machinery should wait until any unsteadiness has completely gone. Pilots, cabin crew, divers and wind or brass players should discuss their work specifically with their surgeon.

Can I shower or swim after stapedotomy?

You can usually shower from the first days if you keep water out of the operated ear. A cotton-wool ball smeared with petroleum jelly works well; wash your hair with the head tilted away from the operated side. Swimming waits until your surgeon has confirmed that the eardrum has healed, commonly at four to six weeks. Jumping or diving into water and swimming underwater usually wait longer.

When can I exercise or drive after stapedotomy?

Walking is fine from the first days. At the Clinique Causse, sport waits two months after an uncomplicated recovery, and longer after a complication. Many other surgeons allow gradual exercise after two weeks and contact sport from six weeks. Do not drive after a general anaesthetic for as long as the anaesthetist advises, and not until you can turn your head quickly without feeling unsteady.

This page provides general educational information. It cannot replace an individual assessment, which depends on a full history, examination, audiometry and, where relevant, imaging. If you have sudden hearing loss, severe pain, facial weakness, severe dizziness or discharge with fever, seek medical care promptly.