Malleus Neck-Anchoring Malleostapedotomy

OBJECTIVE: To compare the hearing outcomes between 2 malleostapedotomy (MS) procedures, handle-MS, connecting the prosthesis with the malleus handle and neck-MS, connecting the prosthesis with the malleus neck. PATIENTS: Fourteen individuals having undergone MS in the setting of otosclerosis or congenital ossicular fixation from January 1983 through December 2009. INTERVENTION: Review of preoperative and postoperative audiometric data, ossicular abnormalities, and postoperative complications. MAIN OUTCOME MEASURES: Postoperative air-bone gap (ABG), closure of ABG, and postoperative changes in bone conduction thresholds. RESULTS: Of 14 patients, 7 underwent handle-MS, and 7 underwent neck-MS. Morphologic or functional abnormalities of the incus were identified in all cases. There was no significant sensorineural hearing loss. The mean postoperative ABGs were 19.8 ± 11.9 dB in the handle-MS group and 14.7 ± 5.5 dB in the neck-MS group. The postoperative ABGs for single frequencies revealed better results for neck-MS at all frequencies (0.25, 0.5, 1, 2, 3, and 4 kHz) without statistical significance. The functional success rate (ABG closure, ≤ 10 dB) was 28.6% for the handle-MS group and 42.9% for the neck-MS group (p > 0.05). CONCLUSION: Inasmuch as neck-MS is easy to perform and yields comparable results to those of handle-MS, it may be an alternative procedure of use in selected cases of otosclerosis or stapes fixation with incus anomaly.