Combined Approach for the Multiple Fixations of the Malleus to the Medial and Anterior Epitympanic Wall

Malleus fixation leads to conductive hearing loss and is a major cause of persistent hearing loss after stapes surgery. It is difficult to visualize and manage malleus fixation to the medial epitympanic wall using an operating microscope. This report describes the case of a 50-yearold woman who was successfully treated with a combined surgical approach. The patient underwent a combined microscopic and endoscopic malleostapedotomy for the surgical correction of multiple malleus fixations to the medial and anterior epitympanic wall along with stapes fixation. The combined surgical technique enabled direct visualization and removal of the fixed lesion with limited atticotomy. The postoperative average air-bone gap was within 20 dB. The study thus showed that combined approach can help minimize the extent of atticotomy as well as identifying and removing the fixed lesion under direct magnification. It is a viable option for the surgical treatment of malleus fixation to the medial epitympanic wall.