Surgery of Idiopathic Malleus Fixation

Objective: To describe and compare 2 different surgical techniques used in treatment of malleus fixation syndrome. Study Design: A retrospective study including 24 patients (25 ears). In 11 of them, the attical fixation was removed via a transmastoid approach without disruption of the ossicular chain. In 14 patients, an ossiculoplasty was performed via a transcanal approach; the malleus head was removed with the incus, and the ossicular chain was reconstructed either by incus interposition (9 cases) or by using a partial ossicular replacement prosthesis (5 cases). The hearing results were analyzed according to the Committee on Hearing and Equilibrium Guidelines of the American Academy of Otolaryngology. Results: In the group of attical fixation removed via a transmastoid approach, the preoperative air-bone gap (ABG) attained 25.2 dB, and the postoperative ABG at 1 year follow-up was 9.1 dB. In the group of ossiculoplasty, the average preoperative ABG reached 26.5 dB, and the postoperative ABG at 1-year follow-up was 8.2 dB. Conclusion: There was no statistically significant difference (p = 0.79) between the 2 surgical techniques used to improve hearing in malleus head fixation.