Stapedectomy for otosclerosis with malleus fixation

Malleus fixation, in addition to stapes fixation, presents a perplexing surgical problem. Should the incus replacement prosthesis procedure be performed or only a stapedectomy? The hearing results of a stapedectomy alone in 45 cases with both stapes and malleus fixation are 70% within 10 dB and 84% within 20 dB of the preoperative bone conduction hearing level.