Malleostapedotomy Revisited: The Advantages of Malleus Neck-Anchoring Malleostapedotomy

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.