Otosclerosis with Incudomalleal Fixation

  • A 39 year old came with an audiogram showing conductive loss and the classical 2K dip.
  • Tympanometry showed As type with absent reflexes.
  • After flap elevation ossicular mobility was checked and all ossicles were found fixed.(video) No evidence of Tympanosclerosis was found.
  • PISA sign was strongly positive as evidence for anterosuperior otosclerotic foci.(picture) reference…
  • Flap incisions were extended superiorly and anteriorly and scutum was exposed. 1 mm cutting burr was used to remove scutum (video) Incudostapedial joint was disarticulated to prevent SNHL.
  • After full attic exposure , incudomalleal complex was cleared .Anterior malleolar ligament and tensor tympani were divided.
  • Post clearance, mobility of Incus and Malleus were restored.
  • Conventional stapedotomy was done with skeeter drill and 0.4 mm Nitinol -teflon piston was placed with fat seal and on-table hearing gain achieved.
  • Otosclerosis with more than 40dB conductive loss , we prefer to use extended incision to expose malleus neck and anterior malleolar ligament. This is the third such case we have encountered.