IT IS DISAPPOINTING to find a significant conductive hearing impairment remaining after an otherwise uneventful stapedectomy for otosclerosis. One of the causes of failure can be malleus head fixation.
Bony fixation of the head of the malleus to the anterior wall of the epitympanum is present in 1.6% of our primary stapedectomy cases and is seen occasionally in a nonotosclerotic ear. The purpose of this report is to review the findings in these cases and to indicate how the problem is handled surgically by members of the Otologic Medical Group.
Causes of Malleus Head Fixation
Malleus fixation can occur as a congenital anomaly1 or develop following otitis media.2,3 The fixation in the cases we are considering here, however, does not appear to be on either basis. The conductive impairments have been progressive and there has been no evidence of previous ear infection in the majority. Three fourths of
Powers WH, Sheehy JL, House HP. The Fixed Malleus HeadA Report of 35 Cases. Arch Otolaryngol. 1967;85(2):177–181. doi:10.1001/archotol.1967.00760040179008