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December 1969

Bilateral Malleal Fixation and Conductive Presbycusis

Arch Otolaryngol. 1969;90(6):759-764. doi:10.1001/archotol.1969.00770030761019

"THE Fixed Malleus Syndrome" as a term applied to fixation of the malleus head (caput mallei) has been described in previous publications.1,2 Undoubtedly, a number of factors may be etiologically significant in this syndrome. Most of the cases reported have been unilateral, although bilateral cases have been noted by Guilford and Anson,3 Davies,4 and Sleeckx et al.5 It is especially in the bilateral case that one is faced with a difficult differential diagnosis.

The syndrome has been encountered both with and without otosclerotic stapes fixation. Much speculation exists with reference to the etiology of malleus fixation when it occurs concomitantly with stapedial otosclerosis. It would probably be helpful to consider such concomitant malleal fixation as "secondary" and due to long continued lateral ossicular deformation as the result of stapedial otosclerosis. Similarly, malleus fixation due to obvious epitympanic tympanosclerosis plaques should be considered secondary. Thus, it would