Conductive hearing loss with a normal tympanic membrane is a common reason for otolaryngology consultation, with otospongiosis being the most frequent cause and House syndrome being extremely rare, requiring systematic investigation. We report the case of a 31-year-old woman who presented with conductive hearing loss with a normal tympanic membrane. A temporal bone computed tomography (CT) scan confirmed a House-Goodhill syndrome due to fixation of the malleus head. Surgical intervention was considered to remove the attic bone synostosis with the malleus head, resulting in a significant clinical improvement. The Goodhill syndrome is a rare condition that causes hearing loss with a normal eardrum. The surgery can highly improve the hearing function.

OBJECTIVE: To examine the clinical features and surgical outcomes in patients with congenital absence of the oval window (CAOW), and to investigate the potential factors that affect audiologic results.
METHODS: A retrospective chart review.
METHODS: A tertiary academic center.
METHODS: A total of 17 ears among 16 patients were confirmed to have CAOW. Among them, 13 ears underwent vestibulotomy for hearing reconstruction. Clinical parameters associated with the hearing outcomes were analyzed.
METHODS: A mean air-bone gap (ABG) after 6-month and long-term follow-up was compared with preoperative measurements.
RESULTS: Intraoperative findings showed that anomalies of the malleus or incus were observed in 11 ears (64.7%), stapes anomalies were present in all ears (100%), and facial nerve anomalies were present in 10 ears (58.8%). Because of unfavorable facial nerve anomalies, hearing reconstruction was aborted in four cases (23.5%). In the hearing reconstruction group, the mean ABG at 6 months postoperation was significantly reduced after compared with the preoperative value (44.0 ± 8.4 dB versus 58.8 ± 9.1 dB, p = 0.006). After dividing ears into a success subgroup (ABG ≤ 30 dB, seven ears) and non-success subgroup (ABG > 30 dB, six ears), the use of a drill during vestibulotomy was significantly related to a poor hearing outcome (100% versus 16.7%, p = 0.015). The long-term follow-up result (mean, 60 mo) revealed no deterioration compared with the 6-month postoperative result. Five ears (29.4%) underwent revision surgery, and three of them showed ABG improvements. No serious complications were reported.
CONCLUSIONS: Vestibulotomy is an effective and safe option for hearing restoration in patients with CAOW, particularly when the use of a drill is not required. The long-term audiologic outcome is also reliable.

OBJECTIVE: The aim of the current study is to compare the surgical and audiometric results of conventional incus interposition (IP) versus malleostapediopexy (MS) in incus long process large defects.
METHODS: A total of 71 patients (incus IP group n = 37, MS group n = 34) were enrolled in this study. All patients enrolled in the current study underwent ossiculoplasty via an exclusive endoscopic transcanal approach. Pre- and postoperative audiometric measurements and air-bone gap (ABG) values were compared, and if the postoperative ABG value was less than 20 dB, ossiculoplasty was considered successful. Graft success rates and complications were also compared.
RESULTS: The average auditory gain was 14.7 ± 4.2 dB in the incus IP group and 18.3 ± 5.1 dB in the MS group. The auditory gain was significantly greater in the MS group relative to the incus IP group (p = 0.012). Ossiculoplasty success (postoperative ABG value < 20 dB) rate was 70.3% in the incus IP group patients and 88.2% in the MS group patients (p < 0.001). There was no significant difference in terms of graft success rate between groups (p > 0.05) and the overall graft uptake rate was 91.5% (65/71).
CONCLUSIONS: Malleostapediopexy-bridging of malleus and stapes using bone cement-is an effective, reasonable, and more efficient technique in terms of auditory outcomes relative to the conventional incus interposition in endoscopic transcanal management of incus long process major defects.

Isolated malleus fractures are a rare occurrence with few reported cases in the literature. Symptoms include sudden otalgia, hearing loss, tinnitus and aural fullness. Work-up and diagnosis are based on a combination of thorough anamnesis and careful otoscopic evaluation or high-resolution computer tomography. We present two cases of isolated malleus handle fractures who were diagnosed based on a combination of pneumatic otoscopy and tympanometry. Both fractures were surgically repaired using hydroxyapatite bone cement as showcased in the supplemental video material. Post-operative audiometry showed improvement in the pure-tone-average of both patients as well as normalisation of tympanometry. Isolated malleus fracture should be suspected in cases of sudden hearing loss and tinnitus following digital manipulation of the outer ear canal together with a conductive hearing loss with a mostly high-frequent air-bone-gap and hypercompliant tympanometry with hypermobility of the tympanic membrane on pneumatic insufflation. Surgical repair of the fracture using bone cement has good hearing outcomes and leads to improvement in auditory symptoms.

To study the morphology and anthropometry of human ear ossicles from cadaveric temporal bone and to study the variations of the human ossicles from ossiculoplasty point of view. 38 sets of ear ossicles were collected, each containing malleus, incus and stapes, from temporal bone dissection done in Vasantrao Pawar medical college, Nashik. They were studied under microscope & anthropometrical, morphological evaluation done. Malleus showed variations in handle where 61% were straight and 39% curved. Weight of malleus ranged from 0.03-0.06 gm. The length ranged from 5.5 to 8.2 mm. Incus showed morphological variation in lenticular process which was present in 73% incii. Weight of incus ranged from 0.04 to 0.09 gm, average length of long process 3.5 mm, width of body 4 mm. In stapes variations was seen with head of stapes which was absent in 21% bones. With increasing awareness about postop hearing status, this study will add up in knowledge of morphological and anthropometric variations that exists in Indian population, help otologists to understand middle ear dynamics better which will improve results of ossiculoplasty.

OBJECTIVE: The outcome of cartilage interposition ossiculoplasty was assessed in cases of incus necrosis after posterior malleus repositioning in the plane of the stapes, in terms of hearing gain after ossicular reconstruction.
METHODS: A retrospective observational study was conducted of 30 patients admitted to an Ain Shams University hospital from March 2021 to September 2021. All patients with ossicular disruption due to chronic suppurative otitis media and hearing loss of more than 40 dB were included in the study. Pure tone audiometry was conducted for each patient after three months, six months and one year post operation.
RESULTS: The audiogram showed a post-operative air-bone gap of 20 dB or less in 83.33 per cent of patients (n = 25) at three months post-operatively and in 80 per cent of patients after six months; after one year, the results remained the same.
CONCLUSIONS: The use of cartilage interposition after malleus posterior mobilisation represents an excellent partial ossicular replacement technique.

OBJECTIVE: Patient-to-image registration is a preliminary step required in surgical navigation based on preoperative images. Human intervention and fiducial markers hamper this task as they are time-consuming and introduce potential errors. We aimed to develop a fully automatic 2D registration system for augmented reality in ear surgery.
METHODS: CT-scans and corresponding oto-endoscopic videos were collected from 41 patients (58 ears) undergoing ear examination (vestibular schwannoma before surgery, profound hearing loss requiring cochlear implant, suspicion of perilymphatic fistula, contralateral ears in cases of unilateral chronic otitis media). Two to four images were selected from each case. For the training phase, data from patients (75% of the dataset) and 11 cadaveric specimens were used. Tympanic membranes and malleus handles were contoured on both video images and CT-scans by expert surgeons. The algorithm used a U-Net network for detecting the contours of the tympanic membrane and the malleus on both preoperative CT-scans and endoscopic video frames. Then, contours were processed and registered through an iterative closest point algorithm. Validation was performed on 4 cases and testing on 6 cases. Registration error was measured by overlaying both images and measuring the average and Hausdorff distances.
RESULTS: The proposed registration method yielded a precision compatible with ear surgery with a 2D mean overlay error of 0.65 ± 0.60 mm for the incus and 0.48 ± 0.32 mm for the round window. The average Hausdorff distance for these 2 targets was 0.98 ± 0.60 mm and 0.78 ± 0.34 mm respectively. An outlier case with higher errors (2.3 mm and 1.5 mm average Hausdorff distance for incus and round window respectively) was observed in relation to a high discrepancy between the projection angle of the reconstructed CT-scan and the video image. The maximum duration for the overall process was 18 s.
CONCLUSIONS: A fully automatic 2D registration method based on a convolutional neural network and applied to ear surgery was developed. The method did not rely on any external fiducial markers nor human intervention for landmark recognition. The method was fast and its precision was compatible with ear surgery.

It is important to know the morphometry of the auditory ossicles for middle ear surgical applications. The present study aims to investigate the morphometric measurements of sheep auditory ossicles and the relationship between these ossicles. In this study, 100 malleus, incus and stapes of 50 Akkaraman sheep were examined using at trinocular stereo microscope and a total of 19 morphometric measurements were taken. The mean values of the morphometric measurements were obtained, and correlation analysis was performed between each part of each auditory ossicle. Similarities were found between the measurements of the lengths of the malleus, manubrium mallei and incus, and the width of the base of the stapes with morphometric measurements in human auditory ossicles. A significant positive correlation was found between the length of the malleus with the length of the manubrium mallei, between the length of the incus with the lengths of the long crus and corpus incudis, between the length of the stapes with the lengths of the rostral crus, caudal crus, caput stapedis, and the length and width of the intercrural foramen. Due to the anatomic similarities between sheep and human auditory ossicles, it was concluded that the auditory ossicles of sheep are suitable for use in the training of human ear surgery applications.

Objective:For tympanosclerosis patients with ossicular chain fixation, we use ossicular chain bypass technique and evaluate its long-term effects. Methods:From June 2017 to June 2019, 147 patients with tympanosclerosis who underwent middle ear surgery with otoscopy in Yinchuan First People\'s Hospital were reviewed. The subjects were divided into three groups according to the implemented operation plan, 51 cases in the ossicular chain mobilization group（OCM）, 56 cases in the ossicular chain bypass reconstruction group（OCB）, and 40 cases in the malleus-incus complex resection reconstruction group（MICR）. Through a three-year follow-up, the medium and long-term effects of different operation plans were compared and analyzed. Results:There was no significant difference among the three groups in the incidence of tympanic membrane perforation, delayed facial nerve palsy, and the dispatch and displacement of PORP. The incidence of tympanic membrane retraction pocket or cholesteatoma after operation in OCB group（0） was significantly lower than that in OCM group（11.76%） and MICR group（7.5%）（P<0.05）. At 12 months after operation, ΔABG of OCB group and MICR group were better than that in the OCM group（P<0.05）. At 36 months after operation, ΔABG of OCB group was better than that in the OCM group（P<0.05）, and there was no significant difference between OCB group and MICR group. The audiological performance of patients with epitympanic sclerosis（ETS） at 12, 24 and 36 months after operation was better than that of patients with posterior tympanosclerosis（PTS） and total tympanosclerosis（TTS）（P<0.05）. Conclusion:Compared with patients undergoing ossicular chain mobilization and malleus-incus complex resection for ossicular chain reconstruction, patients with tympanosclerosis undergoing bypass technique have better and stable hearing prognosis in medium and long term. This technique can effectively prevent the formation of retracted pocket and cholesteatoma in patients with tympanosclerosis after operation.
目的：应用听骨链短路技术治疗伴有听骨链固定的鼓室硬化患者，评价分析手术中远期疗效。 方法：回顾2017年6月至2019年6月于银川市第一人民医院接受耳内镜中耳手术的鼓室硬化患者147例，根据所实施的手术方案将研究对象分为3组，即听骨链松解术（OCM）组51例，听骨链短路技术（OCB）组56例，锤砧复合体切除听骨链重建术（MICR）组40例，通过为期3年的术后随访，对比分析不同手术方案的中远期疗效。 结果：3组在术后鼓膜再穿孔、迟发性面神经麻痹、人工听骨排出及移位发生率比较差异无统计学意义。术后鼓膜内陷袋形成或胆脂瘤的发生率比较，OCB组（0）显著优于OCM组（11.76%）和MICR组（7.5%）（P<0.05）。使用ΔABG来评价术后气骨导差的改善程度，术后12个月OCB组及MICR组均优于OCM组（P<0.05）。术后36个月OCB组ΔABG高于OCM组（P<0.05），OCB组与MICR组在术后36个月ΔABG比较，差异无统计学意义。上鼓室型鼓室硬化（ETS）患者术后12、24及36个月听力学表现优于后鼓室型（PTS）及全鼓室型鼓室硬化（TTS）（P<0.05）。 结论：接受短路技术听骨链重建手术的鼓室硬化患者，相较于接受听骨链松解术以及锤砧复合体切除听骨链重建手术的患者，其听力预后在中远期表现更加优秀且稳定。该技术可以有效预防鼓室硬化患者术后鼓膜内陷袋形成及胆脂瘤的发生。.

To report the case of the simultaneous treatment of otosclerosis and malleus fixation through an entirely endoscopic transcanal approach. A targeted transcanalar epitympanotomy with annular bony ridge conservation was planned preoperatively, with 3D CT localization of the fixed part of the malleus head. The upper part of the malleus head and the superior ossified ligament of the malleus were drilled. A 0.6 mm stapedotomy was performed and a piston inserted. The patient\'s recovery was uneventful, with closure of the air-bone gap on her postoperative audiogram, associated with an overclosure in 500Hz, 1kHz, 2 kHz and 4 kHz. Laryngoscope, 134:2411-2414, 2024.