Absent Stapedial Tendon: A Case Report

The stapedius muscle is a very small skeletal muscle that connects the pyramidal eminence to the stapes through the stapedial tendon. It is very rare that stapedius muscle and tendon are congenitally absent; however, this has been reported previously in the literature and the current report. Our patient was a middle-aged male who presented with hearing loss. On clinical assessment, there were no local or systemic signs and symptoms. However, after an audiological assessment that showed bilaterally mixed hearing loss, the patient was scheduled for left ear exploration and stapedectomy as a case of otosclerosis. Upon exploration, we discovered an absent stapedial muscle tendon and a non-prominent pyramid. Being aware of the stapedius muscle and tendon anomalies is substantial for surgeons performing interventions for middle ear pathologies, and more specifically while operating on patients with otosclerosis, as they showed absent stapedial tendon reflex preoperatively. Although these anomalies are not commonly seen, awareness of their existence and careful interpretation of imaging studies remain crucial.