The role of malleostapedotomy in intra-operative incus injury: A review of 2 cases

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Figure 1
- Audiological test comparing pre and postoperative. A) Pure tone audiometry which was carried out preoperatively showing right hearing with moderately severe up to 2 kHz rising to mild then sloping to moderate conductive hearing loss. Left hearing within the normal level except at 3 kHz with mild hearing loss. The speech reception threshold for right ear was 55 dB HL and 20 dB HL on the left. B) Postoperative pure tone audiometry showing right mild to moderate conductive hearing loss, and the air bone gap improved from 40 dB to 15 dB; hearing in the left side was normal.
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Figure 2
- Audiological test comparing pre and postoperative. A) Preoperative pure tone audiometry showed mild to moderate, up to 3 kHz, slopping to severe mixed hearing loss, and no response at 8 kHz. The left side showed mild to moderate, up to 4 kHz, then slopping to severe mixed hearing loss, and no response at 8 kHz. B) Postoperative pure tone audiometry results showed significant improvement in hearing in right from 250 Hz to 2 kHz with air bone gap improvement from around 40 dB to 0 dB.

Table 1

- Timeline table for case 1.

Date	Relevant past medical history and interventions
2013	26 years old male underwent right ear tympanoplasty twice in peripheral hospital with no improvement in hearing
	From	Diagnostic testing	Interventions
2018/2019	Decreased hearing on the right ear with no improvement at all after the previous surgery	PTA: right hearing loss, moderately severe up to 2 kHz rising to mild then sloping to moderate conductive hearing loss (15/07/2019)	Consented for right revision tympanoplasty with possible ossiculoplasty
November 2019	Confirmed hearing loss and taken to the operating room for right tympanoplasty/with or without ossiculoplasty	Intra-operative finding: anterior inferior dry perforation, mobile lateral chain and fixed stapes.	During the steps for stapes surgery the incus was dislocated accidently by suction movement therefore the patient underwent MS
January 2020	Postoperative: Hearing improved subjectively. On examination: cartilage graft was intact and Weber test lateralized to the right side There were no complications	Postoperative PTA: air bone gap improved from 40 dB to 15 dB (20/01/2020)	Patient was satisfied No further intervention

Table 2

- Timeline table for case 2.

Date	Relevant past medical history and interventions
2019	60-year-old man diagnosed as case of bilateral otosclerosis underwent left stapedotomy and requested surgery on the other side
	Summaries from initial and follow-up visit	Diagnostic testing	Interventions
2019	Presented with decreased hearing on the right ear	Mild to moderate, up to 3 kHz, slopping to severe mixed hearing loss, and no response at 8 kHz. (31/01/2019)	Consented for right end aural stapedotomy
February 2019	Confirmed hearing loss and taken to the operating room for right stapedotomy	IIntra-operative examination: Confirmed the diagnosis	During the surgery, the incus was dislocated accidently, thereafter intraoperative decision was made to perform MS
April 2020	Postoperative: Patient reported improvement of hearing No other otological complaint	Postoperative PTA: significant air bone gap improvement from around 40 dB to 0 dB (23/4/2019)	Patient was satisfied No further intervention