Fixation of the Anterior Mallear Ligament: Diagnosis and Consequences for Hearing Results in Stapes Surgery

Abstract

In the search for possible causes of unfavorable results after stapes surgery, the study reported here focused on the anterior mallear ligament, since it has been previously reported that partial mallear fixation (PMF) leads to functional failure in 38% of cases of stapes revision surgery. The aims of the study were to identify effective methods for the diagnosis of PMF and experimentally assess the conductive hearing loss that results from PMF. The study included vibration amplitude measurements of the ossicles by laser Doppler interferometry (LDI) in 19 patients and 5 fresh human temporal bone (TB) specimens. Analysis of their dynamic behavior was performed by finite element modeling (FEM). Similar, significant changes of manubrium vibration patterns for PMF were found by FEM calculations, in TB experiments, and in patients. We could identify PMF either before operation, using LDI, or during operation, by manual palpation. In the TB experiments and FEM calculations, the attenuation of the stapes displacement due to an isolated PMF was approximately 10 dB and frequency-dependent. Untreated anterior mallear ligament fixation produced a persistent air-bone gap of approximately 10 dB after stapedioplasty.

Keywords

anterior mallear ligament conductive hearing loss laser Doppler interferometry mallear fixation malleus middle ear mechanics otosclerosis stapes surgery

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References

Fisch

Acar

Huber

. Malleostapedotomy in revision surgery for otosclerosis. Otol Neurotol 2001;22:776–85.

Tos

. Bony fixation of the malleus and incus. Acta Otolaryngol (Stockh) 1970;70:95–104.

Subotic

Mladina

Risavi

. Congenital bony fixation of the malleus. Acta Otolaryngol (Stockh) 1998;118:833–6.

Causse

. Eighteen-year report on stapedectomy. I. Problems of stapedial fixation. Clin Otolaryngol 1980;5:49–59.

Plester

. Atlas der Ohrchirurgie. Stuttgart, Germany: Kohlhammer, 1989.

Powers

Sheehy

House

. The fixed malleus head. Areport of 35 cases. Arch Otolaryngol 1967;85:177–81.

Moon

Jr Hahn

. Primary malleus fixation: Diagnosis and treatment. Laryngoscope 1981;91:1298–307.

Nandapalan

Pollak

Langner

Fisch

. The anterior and superior malleal ligaments in otosclerosis: A histopathologic observation. Otol Neurotol 2002;23:854–61.

Huber

Schwab

Linder

. Evaluation of eardrum laser Doppler interferometry as a diagnostic tool. Laryngoscope 2001;111:501–7.

10.

Wada

Metoki

Kobayashi

. Analysis of dynamic behavior of human middle ear using a finite-element method. J Acoust Soc Am 1992;92:3157–68.

11.

Eiber

. Mechanical modeling and dynamical behavior of the human middle ear. Audiol Neurootol 1999;4:170–7.

12.

Ladak

Funneil

. Finite-element modeling of the normal and surgically repaired cat middle ear. J Acoust Soc Am 1996;100:933–44.

13.

Williams

Lesser

THJ

. A finite element analysis of the natural frequencies of vibration of the human tympanic membrane. Part I. Br J Audiol 1990;24:319–27.

14.

Beer

Bornitz

Hardtke

. Modelling of components of the human middle ear and simulation of their dynamic behaviour. Audiol Neurootol 1999;4:156–62.

15.

Evans

. Mechanical properties of bone. Springfield, Ill: Charles C Thomas, 1973:35–6.