Clinical Manifestations and Surgical Results of Malleostapedotomy and Malleostapedectomy / 대한이비인후과학회지

ABSTRACT

BACKGROUND AND OBJECTIVES: Incus stapedotomy is usually performed for the patients with otosclerosis and congenital ossicular fixation. However, for the patients whose incus is absent, anomalous or fixed, the piston wire cannot be placed around the incus. For these cases, malleostapedotomy or malleostapedectomy could be a proper treatment instead of incus stapedotomy. The aim of this study was to evaluate the clinical manifestation and treatment outcome of malleostapedotomy and malleostapedectomy. SUBJECTS AND METHOD: From January 1993 through March 2007, there were four malleostapedotomies and three malleostapedectomies. The medical records of these patients were retrospectively reviewed. The length of piston, ossicular condition, hearing improvement and postoperative complications were investigated. RESULTS: Conventional incus stapedotomy was not possible due to incus anomaly in three cases, incus fixation in two cases, incus removal during the previous surgery in one case and incus defect due to previous surgery in one case. The median length of prosthesis was 5.5 mm. The median preoperative air-bone gap was 42 dB and postoperative air-bone gap was 12 dB. The postoperative air-bone gap level was smaller than 10 dB in three patients, 11-20 dB in one patient, 21-30 dB in one patients, and 31-49 dB in one patient. Except for one case that had extrusion of the prosthesis after eight years, there was no intraoperative or postoperative complication. CONCLUSION: Malleostapedotomy or malleostapedectomy may be a good alternative surgical procedure to routine incus stapedotomy in cases of absence, anomaly or fixation of the incus.