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Alternative Inverted Middle Fossa Approach in Bonebridge Surgery. Technique, Results and Complications.

Mario E Zernotti^1,2,3, Maria F Di Gregorio¹, Máximo Zernotti¹

¹Department of ENT, Universidad Nacional de Cordoba, Sanatorio Allende, Cordoba, Córdoba, Argentina.

International Archives of Otorhinolaryngology

|August 11, 2021

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The novel inverted middle fossa approach (IMFA) offers a viable alternative for Bonebridge surgery, achieving significant audiological improvements in patients with complex ear anatomy. This technique provides comparable results to traditional methods for hearing loss treatment.

Area of Science:

Neurosurgery
Otolaryngology
Audiology

Background:

The transmastoid approach is standard for Bonebridge surgery.
Alternative approaches like retrosigmoid or Middle Fossa Approaches are used for challenging anatomies.
A novel technique, the inverted middle fossa approach (IMFA), is introduced.

Purpose of the Study:

To describe the technique of the inverted middle fossa approach (IMFA).
To evaluate the audiological outcomes of the IMFA in patients undergoing Bonebridge surgery.

Main Methods:

Seven patients with conductive and mixed hearing loss underwent the IMFA.
Pre- and postoperative audiological tests were conducted.
Patients had bone thresholds >40 dB, including cases of aural atresia and syndromic conditions.

Keywords:

aural atresia bone conductive hearing implant conductive hearing loss

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Main Results:

The study included 5 males and 2 females, aged 6-25 years, with an average follow-up of 20 months.
Preoperative air conduction PTA4 was 66.7 dB, improving to 18.9 dB postoperatively.
No significant sensorineural damage was observed, and audiological results were comparable to established methods.

Conclusions:

The IMFA facilitates optimal microphone placement near the ear canal.
This technique is a suitable alternative to conventional approaches for Bonebridge surgery.
Further research is needed to fully establish the benefits of IMFA compared to other methods.