Experimental and clinical studies of malleus fixation

Preoperative clinical diagnosis of malleus fixation can be difficult. "Fixation" of the malleus can be caused by various disorders or diseases: fibrous tissue, bony spurs, and neo-osteogenesis around the malleus head or stiffening of the anterior malleal ligament. The conductive hearing loss produced by these disorders or diseases has not been well characterized. The study goals were 1) to determine the effects of various types of malleus fixation using a cadaveric temporal bone preparation and 2) to assess the clinical utility of umbo velocity measurements in preoperative differential diagnosis of malleus fixation and stapes fixation.

Umbo and stapes velocity were measured in 18 fresh cadaveric human temporal bones with laser vibrometry before and after controlled application of adhesives to the malleus, stapes, or both ossicles.

Each simulated pathological condition produced a specific degree of loss in stapes velocity: stiffening of anterior malleal ligament, 0 to 8 dB; fibrous tissue around malleus head, less than 10 dB; bony bar to malleus head, 10 to 30 dB; and extensive neo-osteogenesis around malleus head, greater than 35 dB. Simulated malleus fixations generally produced similar reductions in both umbo and stapes velocity. Stapes fixation reduced stapes velocity with little change in umbo velocity. Because the change in stapes velocity would be similar to conductive hearing loss, experimental results were directly compared with clinical measurements of umbo velocity in surgically confirmed cases of malleus or stapes fixation. The effects of malleus and stapes fixations between the clinical and experimental data were similar.

The study showed that measurements of umbo velocity and air-bone gap can enable one to diagnose malleus fixation and specifies how to differentiate malleus from stapes fixation.