Explore how specialists at Liv Hospital diagnose middle ear conditions. Learn about advanced hearing tests and imaging scans for stapedectomy planning safely.
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Accurate diagnosis and tests are the foundation of successful stapedectomy surgery, a procedure that restores hearing by correcting otosclerosis in the middle ear. International patients traveling to Istanbul for this specialized care need clear information about what evaluations will be performed before the operation. In this guide we explain the step‑by‑step diagnostic pathway, the technology used, and how results shape the surgical plan. Understanding each test helps patients feel confident, reduces uncertainty, and ensures optimal outcomes.
Stapedectomy is a delicate microsurgical technique performed by ENT specialists with extensive experience in hearing restoration. Because the middle ear structures are tiny and the stakes are high, Liv Hospital follows a comprehensive protocol that combines clinical examination, advanced imaging, precise audiometric measurements, and essential laboratory screening. The following sections detail each component, the reasons they are required, and what patients can expect during their pre‑operative visit.
Stapedectomy is indicated primarily for patients with otosclerosis—a bone remodeling disorder that immobilizes the stapes footplate, leading to conductive hearing loss. The decision to operate begins with a thorough diagnostic assessment that confirms the presence of otosclerotic fixation and excludes other causes of hearing impairment.
Key elements of the diagnostic work‑up include:
Only after these initial steps does the ENT team proceed to more specialized investigations. This staged approach minimizes unnecessary testing, reduces patient burden, and ensures that surgery is truly indicated.
At Liv Hospital, the diagnostic protocol aligns with international guidelines and JCI standards, guaranteeing that each patient receives evidence‑based care before any surgical intervention.
Patients typically seek evaluation when they notice specific auditory changes. Recognizing these symptoms early can lead to timely diagnosis and tests that preserve hearing function.
Typical presenting complaints include:
In some cases, a patient may also experience a “Carhart notch” on audiometric testing—a specific dip in bone‑conduction thresholds that strongly suggests otosclerosis. When these signs appear, the ENT specialist schedules a series of diagnostic procedures to confirm the diagnosis.
Early identification is crucial because otosclerosis can progress, and delaying surgery may lead to irreversible sensorineural damage. Liv Hospital’s multidisciplinary team emphasizes prompt assessment to maintain the best possible hearing outcomes.
High‑resolution imaging provides a visual confirmation of otosclerotic lesions and helps surgeons plan the operative approach. The most commonly employed modalities are:
CT scanning is the gold standard because it visualizes the tiny ossicular chain and any calcified lesions that may impede prosthesis placement. The scan is performed with the patient in a supine position, and the radiation dose is kept as low as possible while preserving diagnostic quality.
In complex cases—such as when a patient reports vertigo or facial nerve symptoms—MRI may be added to rule out alternative diagnoses. All imaging is reviewed by a board‑certified radiologist and the ENT surgeon to ensure a shared understanding of the anatomy.
Pure‑tone audiometry remains the cornerstone of hearing assessment for otosclerosis. The test measures air‑ and bone‑conduction thresholds across frequencies, allowing clinicians to distinguish between conductive and sensorineural loss.
Typical audiometric findings in otosclerosis include:
Additional hearing tests may be ordered:
All results are plotted on an audiogram, which the surgeon uses to predict postoperative hearing gain. At Liv Hospital, audiometric testing is performed in a sound‑treated booth by certified audiologists, ensuring reproducible and accurate data.
Beyond ear‑specific assessments, a set of laboratory tests is required to confirm that the patient is fit for surgery and to identify any underlying conditions that could affect healing.
Standard pre‑operative labs include:
For patients with a history of autoimmune disease or chronic inflammation, additional markers such as C‑reactive protein (CRP) or antinuclear antibodies (ANA) may be ordered. A thorough medication review is also conducted to discontinue anticoagulants or antiplatelet agents as advised by the anesthesiology team.
Liv Hospital’s international patient service coordinates these labs with local providers when patients prefer to have tests done in their home country. Results are uploaded securely to the hospital’s electronic health record, allowing the surgical team to review them before the day of the operation.
Once all diagnosis and tests are completed, the ENT surgeon synthesizes the data to formulate a personalized surgical plan. The key decision points include:
During a pre‑operative consultation, the surgeon reviews the audiogram, imaging, and lab findings with the patient. Visual aids such as 3‑D reconstructions of the temporal bone may be shown to explain the surgical steps. The patient also receives detailed instructions on fasting, medication adjustments, and postoperative care.
In cases where the test results reveal contraindications—such as severe sensorineural loss or active infection—the surgeon may recommend alternative treatments, including hearing aids or medical management, before reconsidering surgery. This transparent, data‑driven approach ensures that every patient undergoes stapedectomy only when the benefits outweigh the risks.
Liv Hospital combines JCI accreditation with a dedicated International Patient Services team, offering a seamless experience from diagnosis to recovery. Our ENT department features surgeons who perform hundreds of stapedectomies annually, utilizing state of the art microscopes and micro‑instruments. International patients benefit from coordinated travel logistics, interpreter assistance, and comfortable accommodation options, all designed to minimize stress and focus on health outcomes.
Liv Hospital Ulus
Asst. Prof. MD. Mustafa Taştan
Otorhinolaryngology
Liv Hospital Ulus
Prof. MD. Abdulkadir Özgür
Otorhinolaryngology
Liv Hospital Ulus
Prof. MD. Ömer Erdur
Otorhinolaryngology
Liv Hospital Vadistanbul
Prof. MD. Ahmet Hakan Birkent
Otorhinolaryngology
Liv Hospital Vadistanbul
Prof. MD. Arzu Yasemin Korkut
Otorhinolaryngology
Liv Hospital Vadistanbul
Prof. MD. Selçuk Güneş
Otorhinolaryngology
Liv Hospital Bahçeşehir
Op. MD. Musa Musayev
Otorhinolaryngology
Liv Hospital Bahçeşehir
Op. MD. Sevim Pırıl Karasu
Otorhinolaryngology
Liv Hospital Bahçeşehir
Prof. MD. Hakan Göçmen
Otorhinolaryngology
Liv Hospital Bahçeşehir
Prof. MD. Kamil Hakan Kaya
Otorhinolaryngology
Liv Hospital Bahçeşehir
Spec. MD. Murat Benzer
Otorhinolaryngology
Liv Hospital Topkapı
Op. MD. Ayfer Ulçay
Otorhinolaryngology
Liv Hospital Topkapı
Op. MD. Recep Haydar Koç
Otorhinolaryngology
Liv Hospital Topkapı
Prof. MD. Yaşar Çokkeser
Otorhinolaryngology
Liv Hospital Ankara
Asst. Prof. MD. Bahar Kayahan Sirkeci
Otorhinolaryngology
Liv Hospital Ankara
Asst. Prof. MD. Merve Tunca
Otorhinolaryngology
Liv Hospital Ankara
Op. MD. Sevinç Bayrak
Otorhinolaryngology
Liv Hospital Ankara
Prof. MD. Doğan Atan
Otorhinolaryngology
Liv Hospital Ankara
Prof. MD. Taylan Gün
Otorhinolaryngology
Liv Hospital Gaziantep
Assoc. Prof. MD. Mustafa Çelik
Otorhinolaryngology
Liv Hospital Samsun
Op. MD. Tunç Üstün
Otorhinolaryngology
Liv Hospital Samsun
Op. MD. Yunus Karadavut
Otorhinolaryngology
Liv Bona Dea Hospital Bakü
Spec. MD. REŞAD QUVALOV
Otorhinolaryngology
Op. MD. Aydın Eroğlu
Otorhinolaryngology
Spec. MD. Reşad Guvalov
Otorhinolaryngology
Send us all your questions or requests, and our expert team will assist you.
The diagnostic pathway starts with a detailed medical history and otoscopic examination to rule out infections. A high‑resolution CT scan (0.5 mm slices) visualizes the ossicular chain and any otosclerotic foci. Pure‑tone audiometry, including bone‑conduction thresholds, confirms conductive loss and may reveal a Carhart notch. Additional hearing tests like speech audiometry and tympanometry provide functional data. Finally, standard laboratory tests—CBC, PT/INR, electrolytes, and blood type—ensure the patient is medically fit for surgery. All results are reviewed jointly by the ENT surgeon and radiologist before proceeding.
A temporal bone CT with sub‑millimeter slices offers excellent bone resolution, allowing the surgeon to see the exact location and extent of otosclerotic deposits. It confirms fixation of the stapes footplate, evaluates the size of the oval window niche, and detects any anatomical variations that could affect prosthesis placement. This information is critical for choosing the correct prosthesis length and for anticipating technical challenges, thereby reducing intra‑operative surprises and improving outcomes.
In otosclerosis, pure‑tone audiometry usually shows a conductive hearing loss pattern: air‑conduction thresholds are raised, especially at low frequencies (500 Hz‑1 kHz), while bone‑conduction thresholds remain within normal limits. The hallmark is a dip—called the Carhart notch—around 2 kHz on the bone‑conduction curve, reflecting stapes fixation. Speech audiometry may reveal reduced word‑recognition scores, and immittance testing often shows reduced stapedial reflexes. Post‑operative audiograms typically demonstrate improved air‑conduction thresholds and resolution of the Carhart notch.
Before surgery, Liv Hospital orders a complete blood count to detect anemia or infection, and a coagulation panel (PT/INR and aPTT) to ensure normal clotting. Serum electrolytes and renal function tests are checked to confirm safe anesthesia administration. A blood type and screen are performed in case a transfusion is unexpectedly needed. For patients with autoimmune or inflammatory conditions, additional markers such as CRP or ANA may be requested. All results are uploaded to the electronic health record for the surgical team’s review.
Otosclerosis is a progressive condition; while the primary loss is conductive, prolonged disease may cause inner‑ear involvement, resulting in sensorineural hearing loss that cannot be corrected surgically. Delaying surgery also prolongs the patient’s difficulty understanding speech, especially in noisy environments, and may increase the psychosocial impact of hearing impairment. Early intervention, when the disease is still primarily conductive, offers the best chance for optimal postoperative hearing gain.
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