Ossiculoplasty for Congenital Middle Ear Malformations

Congenital middle ear anomalies are relatively rare but significant causes of pediatric conductive hearing loss. The Teunissen and Cremers classification, determined intraoperatively, guides tailored surgical management: stapes surgery for class I, combined ossiculoplasty and stapes surgery for class II, tympanoplasty for class III, and vestibulotomy for class IV. Transcanal endoscopic ear surgery provides hearing outcomes comparable to microscopic ear surgery, with advantages in visualization and minimal invasiveness. Class IV anomalies carry a high risk of facial nerve and inner ear injury; thus, hearing aids or bone-anchored devices are often recommended for younger patients or when surgical risks are substantial.