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In stapedotomy for otosclerosis, a prosthesis is placed in an opening of about 0.4–0.7 mm in the stapes footplate, in contact with the inner-ear fluid that the hearing and balance organs share. A fine taste nerve crosses the operating field. So hearing, balance, tinnitus and taste can all change afterwards.
The urgency levels below follow when to contact your surgeon; your own surgeon’s instructions come first.
One rule overrides the rest: a sudden loss of hearing in the operated ear, or severe spinning vertigo, needs review the same day. If you cannot reach your surgeon, go to an emergency department and say which operation you had, and when.
Dizziness and vertigo
Common. Unsteadiness or a brief sense of movement when you turn your head is common in the first days. Reported rates vary from a few per cent to over half, depending on how it is asked. It usually settles within five to seven days and rarely lasts beyond four weeks. Do not drive while you are unsteady.
Positional vertigo. Spins of 10–20 seconds when lying down or turning over in bed, starting one to three weeks after surgery, can be benign paroxysmal positional vertigo (BPPV), caused by loose crystals in a balance canal. One prospective series found it in 8.5% of patients, beginning between day 5 and day 21. It is treated with a repositioning manoeuvre, not further surgery.
What suggests a problem. Dizziness that persists or worsens; dizziness set off by loud sound, straining, nose-blowing or sneezing; dizziness with falling hearing. Causes to consider are a prosthesis that is too long, a perilymph fistula (inner-ear fluid leaking around the prosthesis), a reparative granuloma (an inflammatory reaction around it) and serous labyrinthitis (irritation of the inner ear).
What to do. Dizziness beyond the first days, or provoked by sound or pressure: call within a day or two. Severe or spinning vertigo, especially with vomiting: same day. Lingering dizziness without a structural cause usually responds to vestibular rehabilitation.
Tinnitus
Common. Ringing or rushing is common while the ear is packed and blocked, because outside sound no longer masks it.
Time course. Tinnitus tends to follow hearing, fading as the ear opens up over weeks to months. In pooled studies of people who had tinnitus before stapes surgery, it disappeared in about half and lessened in roughly another quarter; it was unchanged in about one in five and worse in about one in twenty-five.
What suggests a problem. New, loud or clearly worsening tinnitus, especially with falling hearing or dizziness, which points to the inner ear.
What to do. Loud new or worsening tinnitus: call within a day or two. With sudden hearing loss or severe vertigo: same day.
Taste disturbance and dry mouth
Why it happens. The chorda tympani carries taste from the front two-thirds of the tongue on the same side, and crosses the middle ear in the surgeon’s path to the stapes. It is usually preserved but often has to be moved or stretched aside. It also supplies two of the salivary glands, so some people notice a dry mouth.
Common and expected. A metallic, salty or dull taste on one side of the tongue. In a series of 320 patients, about a third reported a taste disturbance at one week, fewer than one in ten at six weeks and fewer than one in a hundred at one year. A pooled analysis of smaller studies found early changes in nearly half and lasting changes in about one in seven; the figure depends on how carefully taste is measured.
What to do. Taste change alone is not a sign that the operation has failed and needs no urgent review. Mention it at follow-up, particularly if it persists after several months. If the other ear may be operated on later (see bilateral otosclerosis), tell the surgeon: taste loss and dryness on both sides are more troublesome than on one.
Blocked or muffled hearing
Common and expected. With packing, blood and swelling in the ear, the operated ear often hears worse than before surgery for one to two weeks, with a blocked feeling, a booming voice of your own, and popping as the ear clears. This says nothing about the result. Hearing usually opens up once the packing is out and keeps changing for two to three months; the definitive audiogram is at three to six months. See stapedotomy recovery and recovery after ear surgery.
What suggests a problem. A blocked middle ear and a struggling inner ear can feel alike. A simple check some surgeons suggest: hum with your mouth closed. While the operated ear is blocked, the hum normally sounds louder in that ear. If it now sounds louder in the other ear, the inner ear may be affected. This is a rough guide only, and less reliable if the other ear also hears poorly.
What to do. Muffled hearing that is stable or improving: no call needed. A hum that has switched sides, or an ear that has gone dead: same day.
Hearing that improves, then falls
Early. Sometimes hearing is clearly better at first and then declines within days to weeks. The causes that matter are reparative granuloma, perilymph fistula and serous labyrinthitis; all can damage the inner ear, and all are more treatable when recognised early. Reparative granuloma is rare. In a series of 19 patients who had one, symptoms began on average within four days of surgery; revision relieved the vertigo in 18, but only 11 kept serviceable hearing.
Late. A slow decline months or years later usually has a mechanical cause: a shifted prosthesis, erosion of the incus where it is attached, scar tissue or new bone. These are among the reasons revision is eventually needed in 5–10% of ears.
What to do. A sudden or marked drop: same day. Hearing slipping back over a few days: call within a day or two. Gradual fading over months: contact your clinic for an audiogram; not an emergency, but earlier assessment keeps more options open.
Sudden hearing loss
What it means. The ear goes quiet or dead over minutes to hours, often with spinning vertigo or loud tinnitus. Severe or total inner-ear loss follows about 0.5–1% of first operations, at surgery or days to weeks later. A perilymph fistula, a granuloma or inner-ear inflammation may be responsible; occasionally coughing or sneezing dislodges the prosthesis or its seal.
What to do: same day. Call your surgeon or, if they cannot be reached, go to an emergency department. Practice varies: steroids are often started promptly, and a suspected leak or granuloma may need exploration. The earlier the assessment, the more can be done. Meanwhile avoid straining and nose-blowing, and do not fly until your surgeon agrees (see flying after ear surgery).
Sensitivity to loud sounds or distortion
Common. Once the ear opens up, cutlery, running water or your own chewing can seem too loud, sharp or tinny while the brain recalibrates after years of muffled sound. The stapedius muscle, which tightens the ossicular chain against loud sound, is usually disconnected during the operation, though how much that matters is uncertain. The sensitivity generally fades over weeks to a few months.
What suggests a problem. Distortion with falling hearing, or loud sounds that make you dizzy. Sound-induced dizziness can indicate a prosthesis that is too long or an inner-ear problem.
What to do. Sensitivity alone: give it time. Dizziness provoked by sound: call within a day or two.
Facial weakness (rare)
Two situations. Local anaesthetic can reach the facial nerve and weaken the face for a few hours; this wears off. Much less often, weakness appears days later. In a systematic review of delayed facial palsy after ear surgery of all kinds, it began on average about eight days after the operation and recovered fully in 93%, mostly within a month. Reactivation of a dormant virus is the explanation most often proposed, and treatment follows that for Bell’s palsy: steroids, sometimes with antiviral medication.
What to do: same day if weakness appears after your face had been normal, or does not wear off within hours. Protect the eye if it does not close fully.
Timing and work-up of vertigo or hearing loss after stapedotomy
First days: serous labyrinthitis, pneumolabyrinth, or an over-length piston (typical length 4.25–4.75 mm) intruding into the vestibule. Days to three weeks: reparative granuloma (mean onset 3.6 days in the Krief series; 7–15 days in older reports cited by Necula), BPPV (day 5–21, Magliulo) and perilymph fistula. Later: fistula after barotrauma, displacement, incus erosion, endolymphatic hydrops. Work-up: masked bone conduction against the early post-operative baseline, fistula test, Dix–Hallpike, high-resolution CT for piston depth, air and soft tissue in the vestibule or niche, and gadolinium MRI if granuloma or labyrinthitis is suspected. Falling bone conduction with suspected granuloma or fistula favours early exploration. Persistent dizziness without a structural cause should prompt consideration of vestibular migraine and persistent postural-perceptual dizziness.
Sources
- Necula V, Maniu AA, et al. Vertigo associated with otosclerosis and stapes surgery: a narrative review. Medicina (Kaunas). 2023;59(8):1485. PubMed
- Magliulo G, Gagliardi M, et al. Stapedotomy and post-operative benign paroxysmal positional vertigo. J Vestib Res. 2005;15(3):169-172. PubMed
- Yeh KT, Zhang BY, et al. Tinnitus and hearing outcomes following stapes surgery in otosclerosis patients: a systematic review and meta-analysis. Am J Otolaryngol. 2026;47(6):104957. PubMed
- Saki N, Nikakhlagh S, 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
- Coelho DH, Lee S, et al. Subjective and objective taste change after stapes surgery: systematic review and meta-analysis. Otol Neurotol. 2023;44(1):10-15. PubMed
- McManus LJ, Stringer MD, Dawes PJ. Iatrogenic injury of the chorda tympani: a systematic review. J Laryngol Otol. 2012;126(1):8-14. PubMed
- Krief A, Ayache D, et al. Surgical management of stapedo-vestibular reparative granuloma following otosclerosis surgery: a STROBE retrospective study. J Otolaryngol Head Neck Surg. 2025;54:19160216251364762. PubMed
- Walters B, Patel S, et al. Delayed facial nerve palsy following otological surgery: systematic review and narrative synthesis. J Laryngol Otol. 2025;139(12):1127-1135. PubMed
Common questions
Is dizziness normal after stapedotomy?
Yes, in the first days. Brief unsteadiness, or a spinning feeling when you move your head, is common because the prosthesis sits in an opening to the inner-ear fluid, which the balance organ shares. It usually settles within about a week. Dizziness that lasts beyond the first days, gets worse, or is set off by loud sound or straining should be reported within a day or two. Severe spinning vertigo with vomiting needs same-day review.
How long does taste change last after stapes surgery?
Usually weeks to a few months. The taste nerve crosses the middle ear and is often stretched during the operation, which can leave a metallic or dull taste on one side of the tongue. In one large series, a third of patients noticed it at one week, fewer than one in ten at six weeks and fewer than one in a hundred at a year. Other studies report lasting changes more often.
Why is my hearing worse after stapedotomy?
In the first weeks this is expected. Packing, blood and swelling in the ear block sound, so the operated ear often hears less than it did before surgery. Hearing usually opens up once the packing is out and goes on changing for two to three months; the result is judged at three to six months. A sudden further loss, or an ear that goes completely dead, is different and needs same-day review.
Will tinnitus go away after stapedotomy?
It often improves. In pooled studies of people who had tinnitus before stapes surgery, it disappeared in about half and lessened in roughly another quarter; it stayed the same in about one in five and became worse in about one in twenty-five. It is often louder in the first weeks while the ear is blocked. New, loud tinnitus with falling hearing or dizziness should be reported promptly.
Why do loud sounds seem harsh or distorted after stapes surgery?
After years of muffled hearing, sound reaching the inner ear normally again can seem sharp, tinny or too loud, and a small muscle that damps loud sound is usually disconnected during the operation. This generally settles over weeks to a few months as the brain adjusts. If loud sounds make you dizzy, or distortion comes with hearing that is getting worse, contact your surgeon within a day or two.
When is a symptom after stapedotomy an emergency?
Seek care the same day for a sudden loss of hearing in the operated ear; severe or spinning vertigo, especially with vomiting; facial weakness that appears after your face had been normal, or that does not wear off within hours; heavy bleeding; or severe headache with fever, neck stiffness or drowsiness. If you cannot reach your surgeon, go to an emergency department and say which operation you had, and when.
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.