![]() ![]() Congenital ossicular abnormalities: a review of 68 cases. Congenital malformations of the ear: analysis of 94 operations. Minor anomalies are restricted to the middle ear, whereas major anomalies can involve the middle ear, external meatus, and auricle. The many different types of congenital ossicular anomalies can be broadly divided into major and minor ear anomalies. (B) The gap between the malleus neck and posterior bony wall after partial removal of the malleus bar using microcurett. (A) The malleus bar (arrows) between malleus neck and posterior bony canal. A postoperative PTA acquired at 6 months showed that the air-bone gap was closer to a normal range than it was on the preoperative PTA ( Fig. The patient experienced subjective hearing gain after the removal of the rosebud packing. After repositioning the tympanomeatal flap, rosebud packing was performed using nylon mesh with antibiotic-impregnated Merocel packing. A small piece of thin silastic sheet was placed between the repaired sites to reduce the potential for refixation. 4B), but a remnant of the malleus bar was present. An approximately 2 mm space was present between the bony annulus and malleus ( Fig. Malleus release was accomplished using a Shea microcurette (1.5 mm) instead of a Skeeter drill. The malleus was immobile, but the incudostapedial joint showed mobility. After elevation of the tympanomeatal flap, the congenital malleus bar was identified ( Fig. Traditional “12 o'clock” and “6 o'clock” incisions were made. All procedures were performed via a transcanal approach. The patient received local anesthesia via a standard four-quadrant canal injection with 1% lidocaine and 1:100,000 epinephrine. Temporal bone CT showed an atypical malleus bar ( Fig. His preoperative Pure-Tone Audiogram (PTA) showed conductive hearing loss on the right side ( Fig. His response to the Valsalva test was normal. However, a white band-like mass mimicking myringosclerosis was noted in the right tympanic membrane ( Fig. Otoendoscopic examination showed that the external auditory canal and tympanic membrane were normal. He had no history of ear disease such as otitis media. ![]() Case reportĪ 16 year-old boy presented with right-sided hearing loss that had been present since childhood. The conductive hearing loss improved after surgery. We report a case of congenital malleus bar with a normal external auditory canal that was treated using a fine microcurette and an interfaced silastic sheet. Trauma to the inner ear can only be avoided by minimizing noise. Despite these adverse effects of drilling, the high noise levels during ear surgery cannot be reduced to any great extent. However, the drill-induced high noise levels are harmful to the inner ear, and drilling at the malleus bar can induce sensorineural hearing loss and tinnitus. Rehabilitation involves drilling or excising the bony or fibrous connection that impairs ossicular mobility. a patient was found to have bilateral malleus bar and congenital aural atresia. Malleus bar: an unusual ossicular abnormality in the setting of congenital aural atresia. In the study by Carfrae et al., 2 2 Carfrae MJ, Jahrsdoerfer RA, Kesser BW. To date, congenital malleus bar has only been reported in the setting of congenital aural atresia or a narrow external auditory canal. Preoperative evaluation of congenital malleus bar by using temporal bone CT is difficult. The bar fixes the malleus and ossicular chain in place. to describe a bar of bone extending from the malleus neck to the posterior bony annulus. Congenital malleus bar is a term coined by Nomura et al. Congenital fixation of the malleus and incus is an uncommon cause of conductive hearing loss.
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