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The principle of the operation of stapedectomy is to bypass the obstruction to sound conduction through the middle ear, namely the fixed footplate of the stapes.

Whether or not the surgeon practises second-ear stapedectomy, the ear chosen for initial surgery should be the worse-hearing ear. Operation on the onlyhearing ear is contraindicated (as for most major ear operations), because of the risk of producing total deafness, except under the most unusual circumstances (eg where one ear is completely dead and the other is so profoundly impaired that hearing-aid use is no longer effective). Stapedectomy should be undertaken with caution in those who are highly dependant upon perfect balance for their occupations or hobbies (eg steeplejacks, mountaineers) and in those who work in noise, because the inner ear after stapedectomy is believed to be more sensitive to damage by high-intensity sound.