Two Cases of Malleostapedotomy in Congenital Oval Window Atresia
A 10-year-old male visited our outpatient clinic with bilateral hearing loss for several years. Audiometric evaluation showed bilateral conductive hearing loss (), and TBCT revealed bilateral atresia of the oval window, with an abnormal array of the facial nerve (). Explo-tympanoplasty was performed primarily on the left ear with an ossiculoplasty using a TORP; there was no hearing improvement. A stapedotomy was planned using a retroauricular approach. During the operation, the malleus showed normal images, but the long process of the incus was short. In addition, the stapes were missing, and the facial nerve was lying over the obstructed oval window. The facial nerve was cephalically rotated using the "facial roll" method, and a 0.6-mm window was created at the center of the stapes footplate using a 0.4-mm Skeeter drill. A 7-mm-long piston wire was fixed on the malleus and tightened with piston forceps (). Immediately postoperatively, the patient showed no dizziness or loss of taste, but mild facial palsy, House-Brackmann Grade III, was noted. By 1 month later, the facial palsy had recovered, to Grade I, and the ABG was reduced, from 40 dB (pre-operative) to 15 dB (6 month post-operative) on pure tone audiometry ().