Malleostapedotomy revisited: the advantages of malleus neck-anchoring malleostapedotomy

Otol Neurotol. 2014 Oct;35(9):1504-8. doi: 10.1097/MAO.0000000000000524.


Objective: To extend our preliminary study by comparing the hearing outcomes of handle-malleostapedotomy (handle-MS; connecting the prosthesis to the malleus handle) and neck-MS (connecting the prosthesis to the malleus neck) in a larger case series.

Patients: Thirty-five patients who underwent MS at Seoul National University Hospital from January 1983 to December 2013.

Intervention: Review of pre- and postoperative audiometric data, intraoperative findings.

Main outcome measures: Postoperative air-bone gap (ABG) and closure of ABG.

Results: In 11 of 20 patients (55.0%) in the handle-MS group and 12 of 15 (80%) in the neck-MS group, the postoperative ABG closed to within 20 dB HL. For frequencies of 0.25, 0.5, 1, 2, 3, and 4 kHz, the ABGs did not differ significantly between the two groups. The postoperative ABG closure was lower in the neck-MS group (22.3 ± 12.6 dB HL) than in the handle-MS group (23.5 ± 11.6 dB HL), but without statistical significance (p = 0.78). Four patients in each group underwent MS as a revision procedure. One of them underwent neck-MS as revision surgery because of prosthesis extrusion after handle-MS. The mean ABG closure at 1 year postoperatively in patients who underwent revision neck-MS (19.9 ± 11.9 dB HL) was not different from that of the patients who underwent revision handle-MS (20.9 ± 8.7 dB HL).

Conclusion: As neck-MS provided results comparable to those of handle-MS in our extended case series, it might be a useful procedure in selected cases of otosclerosis or stapes fixation with an incus anomaly, especially in revision cases after handle-MS.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Audiometry
  • Bone Conduction
  • Child
  • Ear Diseases / surgery*
  • Female
  • Hearing
  • Hearing Loss, Conductive / surgery
  • Hearing Tests
  • Humans
  • Incus / surgery
  • Male
  • Malleus / surgery*
  • Middle Aged
  • Prostheses and Implants
  • Seoul
  • Stapes Surgery / instrumentation*
  • Stapes Surgery / methods*
  • Young Adult