Surgery of isolated malleus fixation due to tympanosclerosis

Abstract

The aim of the present study was to describe our surgical approach for isolated malleus fixation in patients with tympanosclerosis and to analyze the postoperative results. A total of 30 patients presented with isolated malleus fixation were operated. The fixation was reached via canalplasty. Fixated areas were cleaned without damaging the ossicle. Pre- and postoperative audiometric results were evaluated for each patient. Improvement of the pure-tone average (PTA) by at least 10 dB and an air-bone gap (ABG) of less than 20 dB after 12 months of follow-up was accepted to indicate success. The recovery of the postoperative PTA and ABG measurements was significant. Pre- and postoperative PTA was 48.00 ± 11.86 and 24.90 ± 12.45 dB, respectively (p < 0.001). According to PTA measurements, 40-50 dB recovery was achieved in four (13.3 %) patients, 31-40 dB in six (20 %) patients, 21-30 dB in ten (33.3 %) patients, and 11-20 dB in five (16.6 %) patients, with a total success rate of 25/30 (83.2 %). Pre- and postoperative ABG levels were 38.95 ± 9.92 and 16.10 ± 7.79 dB (p < 0.001), respectively. The ABG level was between 0 and 10 dB for 8 (26.6 %) patients, and 11-20 dB for 16 (53.3 %), with a total success rate of 24/30 (80 %). In cases of isolated malleus fixation with tympanosclerosis, performing a canalplasty to clean the sclerotic plaques without damaging the normal anatomy of the ossicle system using a diamond burr is a safe surgical option that provides significant recovery in hearing levels.

Ossicular chain mobilisation versus reconstruction in surgery for isolated malleus and/or incus fixation: systematic review and meta-analysis

“…Katzke and Plester, and others in favour of ossicular chain mobilisation, believe that preserving the continuity of the ossicular chain will best approximate normal physiological function and restore hearing 4 . The traditional ossicular chain mobilisation technique involves using a bone drill or diamond burr to drill away the bony fixations contributing to the conductive hearing loss, and then introducing a physical barrier between the ossicles and the epitympanum, such as Silastic® sheeting 3 – 5 , 10 , 11 or a fascia graft, 17 to prevent refixation. More recent advances in this technique include the use of lasers for fixation release.…”

“…Seidman and Babu used a potassium titanyl phosphate laser for initial fixation release, but still used a burr for atticotomy and creating adequate space around the ossicles 3 . Three papers comment on the importance of creating 2 mm of space around the previously fixed ossicle in order to adequately prevent refixation 3 , 4 , 17 …”

“…Most papers in this review did not directly compare outcomes based upon congenital versus acquired causes of fixation. Five studies included only patients with tympanosclerosis 6 , 11 , 17 , 21 , 22 . The average air–bone gap amongst those studies was 15.84 dB for ossicular chain mobilisation, with 28.9 per cent having an air–bone gap of 10 dB or less, whereas the average air–bone gap for ossicular chain reconstruction was 17.61 dB, with 21.5 per cent having an air–bone gap of 10 dB or less.…”

“…Some studies had very standardised treatment, while others utilised different surgical methods throughout the study. For example, Sakalli et al 17 . and Stankovic 21 explicitly state that the same experienced surgeon performed all operations with the same technique throughout the study, but most studies did not exhibit the same degree of consistency.…”

“…Five authors described using Silastic sheeting, 3 – 5 , 10 , 11 while Guilford and Anson used Teflon sheeting, 9 Sakalli et al . used a temporalis fascia graft, 17 and five studies made no mention of a physical barrier at all 6 – 8 , 22 , 23…”