The stapedius tendon emerges from the apex of the pyramidal eminence on the posterior wall of the middle ear and inserts on the neck of the stapes. Stapedius is the smallest skeletal muscle in the body and is supplied by the facial nerve. Its contraction tilts the stapes footplate and reduces sound transmission to the cochlea.
Pulls the stapes backwards to damp its movement and protect the inner ear from loud sound
The stapedius tendon is the efferent limb of the acoustic reflex, which is tested in audiology to help localise hearing loss and facial nerve lesions. Facial nerve palsy proximal to the nerve to stapedius causes hyperacusis, an uncomfortable loudness of ordinary sounds. The tendon is routinely divided during stapedectomy for otosclerosis.
Loss of stapedius action after a facial nerve lesion above the nerve to stapedius makes normal sounds feel painfully loud on the affected side.
Disruption of the stapedius tendon or its nerve, or fixation of the stapes, abolishes the acoustic reflex measured on tympanometry.
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