Malleus bar: an unusual ossicular abnormality in the setting of congenital aural atresia

Malleus bar is a rare cause of conductive hearing loss and has yet to be described in the setting of congenital aural atresia. This study aimed to define the anomaly and review the surgical management and outcomes of patients found to have a malleus bar in the setting of congenital aural atresia.

Retrospective case review of patients with malleus bar and congenital aural atresia.

Tertiary otologic referral center.

Patients found to have a malleus bar at the time of surgery for congenital aural atresia.

Charts of patients who underwent surgery for congenital aural atresia repair with a malleus bar were reviewed for demographic data, preoperative Jahrsdoerfer score, surgical findings, and audiometric data.

Seven subjects (8 ears) were identified to have a malleus bar and congenital aural atresia. In all 8 ears, the malleus bar proved to be a second point of attachment of the ossicular chain in addition to the atretic plate. The chorda tympani nerve was found in the bony bar in 4 patients. Closure of the air-bone gap within 35 dB hearing level (HL) was achieved in 83% of patients. All patients showed improved speech reception thresholds and stable bone-conduction thresholds. All but 1 patient had stable or improved word recognition scores.

Malleus bar in the setting of congenital aural atresia represents a rare combination of causes of congenital conductive hearing loss. Patients with these 2 abnormalities obtain good short-term results with surgical repair of congenital aural atresia.