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Transcanal Endoscopic Ear Surgery for the Management of Congenital Ossicular Fixation

Zhu, Vivian F.; Kou, Yann-Fuu; Lee, Kenneth H.; Kutz, Joe Walter Jr.; Isaacson, Brandon

doi: 10.1097/MAO.0000000000001154

Objectives: 1) To describe the technique for transcanal endoscopic management of congenital ossicular chain fixation. 2) To highlight the utility and outcomes of the endoscopic approach for management of congenital ossicular fixation.

Study Design: Retrospective patient series.

Setting: Academic tertiary pediatric hospital.

Patients: Pediatric patients (age 6–12) undergoing transcanal endoscopic management of congenital ossicular fixation from May 2014 to December 2014.

Interventions: A transcanal endoscopic approach was used in eight procedures. Ossicular chain pathology was managed with either mobilization, ossiculoplasty with a stapes prosthesis, or incus interposition.

Main Outcome Measures: Pure-tone averages, speech reception thresholds, and speech discrimination scores were recorded pre- and postoperatively for each subject. Preoperative computed tomography evaluations were compared to intraoperative findings for each subject.

Results: An improvement in the pure-tone average, as well as air-bone gap, was noted after six of eight procedures. No patients experienced a complication or a reduction in their bone conduction hearing. The chorda tympani nerve was preserved in all eight patients. Conversion to open approach was not necessary for any of the eight procedures performed.

Conclusion: The transcanal endoscopic approach was successful in improving hearing in pediatric patients with congenital ossicular fixation that involves any of the three ossicles. An endoscopic transcanal approach provides an alternative method to manage congenital ossicular pathology with the advantage of providing excellent visualization and the avoidance of a postauricular incision.

Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

Address correspondence and reprint requests to Brandon Isaacson, M.D., F.A.C.S., Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9035; E-mail:

B.I.—consultant and course instructor at Medtronic Midas Rex Institute. Advanced Bionics Medical Advisory Board. Stryker Consultant, Olympus consultant, Oticon consultant.

Presented at the American Academy of Otolaryngology, September 28, 2015, Dallas, TX.

The authors disclose no conflicts of interest.

Copyright © 2016 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company