Stapedius bony bar as an unusual cause of stapes fixation: Case report

This report describes a case of bilateral stapedial superstructure fixation by a stapes-pyramid bony bar with a mobile footplate, which is an extremely rare occurrence among the ossicular malformations that cause conductive hearing impairment. A 23-year-old female with bilateral hearing impairment since childhood presented to our department. The Otoscopy was normal, and pure tone audiometry showed bilateral mixed hearing loss with Carhart notch. An abnormal bony bar bridging between the posterior crura and the pyramid was found in temporal bone CT scan of both ears. An exploratory tympanotomy via trans-canal approach was conducted and a bony bar between the superstructure of the stapes and the pyramid, just lateral to stapedial tendon, was encountered on both sides. Stapes mobility was restored by removing the bony bar. Postoperative audiometry showed complete closure of air-bone gap. Thus, regarding the surgery of patients with stapes fixation, surgeons should be aware of the possibility of stapedial superstructure fixation with mobile footplate.