Epitympanic malleus fixation: correction without disrupting the ossicular chain

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Innovation

Background:

• Malleus fixation, often diagnosed via pneumatic otoscopy, presents a surgical challenge.
• Traditional treatments disrupt the ossicular chain, necessitating reconstruction.
• A modified surgical approach is crucial for managing epitympanic malleus fixation.

Observation:

• A wide, inferiorly based tympanotomy flap provides optimal access to the epitympanum.
• Atticotomy and osteotomy can free the malleus while maintaining ossicular chain integrity.
• This approach was evaluated in 46 patients with congenital and acquired bony epitympanic malleus fixation.

Findings:

• Preserving the anatomical continuity of the ossicular chain is achievable in over 90% of cases.
• Maintaining an intact, albeit modified, ossicular chain results in a smaller residual air-bone gap.
• Surgical modification allows for definitive resolution of conductive hearing loss.

Implications:

• This technique offers improved hearing outcomes for patients with malleus fixation.
• It highlights the importance of preserving ossicular chain integrity during middle ear surgery.
• Refined surgical strategies can enhance the management of conductive hearing loss due to malleus fixation.