Use of the Argon Laser in the Treatment of Malleus Fixation

Abstract

This case demonstrates the use of the argon laser for ossicular mobilization. A preoperative audiologic evaluation revealed a severe conductive hearing loss, with a maximum air-bone gap. Since normal drilling procedures would result in a sensorineural hearing loss, the argon laser was chosen to remove a bony spur connecting the malleus to the posterior canal wall. When using the argon laser, no disarticulation of the incus and stapes is required. Postoperative audiologic evaluation revealed normal hearing sensitivity bilaterally.

Ossiculoplasty for Malleus Bar with Incudostapedial Disconnection and Fused Incudomalleolar Joint

“…e surgical procedure must be adapted based on an unexpected intraoperative finding, such as adhesive incudomalleolar joint, which is difficult to identify by preoperative CT. e incudostapedial joint was missing in this case. Previous case reports have described patients with malleus bar and no other malformations of the ossicles [2,3,5]. In such cases, only removal of the malleus bar is needed to improve hearing.…”

“…The incudostapedial joint was missing in this case. Previous case reports have described patients with malleus bar and no other malformations of the ossicles [ 2 , 3 , 5 ]. In such cases, only removal of the malleus bar is needed to improve hearing.…”

“…Malleus bar is a rare congenital malformation of the middle ear, consisting of a bony bar connecting the tip of the malleus handle and the posterior wall of the tympanic cavity [1]. Although congenital aural atresia or stenosis often accompanies it, intact ossicular chains have been reported with this anomaly in many cases [1][2][3][4]. In such cases, only removing the bony bar improves the hearing level [2].…”

“…Although congenital aural atresia or stenosis often accompanies it, intact ossicular chains have been reported with this anomaly in many cases [ 1 – 4 ]. In such cases, only removing the bony bar improves the hearing level [ 2 ]. However, surgical management is challenging in cases of malleus bar accompanied by other malformations of the ossicles.…”