Malleus relocation in ossicular reconstruction: managing the anteriorly positioned malleus: results in a series of 268 cases

The objective of this study was to report an original method of malleus relocation allowing for better placement of both partial and total prostheses in ossicular reconstruction. We conducted a retrospective review of clinical and audiometric findings. A tertiary referral center. This is a study of 268 patients who underwent ossiculoplasty surgery from October 1997 to October 2000 for chronic otitis media, noninflammatory disease, and otosclerosis revision. Malleus relocation with total and partial ossicular replacement prostheses was used in all cases. Audiometric assessment included pre- and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. A postoperative air-bone gap closed to within 10 dB was achieved in 56% of cases. An air-bone gap smaller than 20 dB was obtained in 78% of cases. Postoperative improvement of air-conduction thresholds superior to 20 dB was found in 41.5% of cases. The postoperative bone-conduction thresholds were unchanged in 98% of cases. One case of total postoperative sensorineural hearing loss was seen in this series (0.4%). Extrusion of the protheses was not observed in this series. Follow up ranged from 6 to 36 months (mean, 12.4 months). This study shows that malleus relocation is a safe and efficient technique for ossicular reconstruction. The ideal position of the relocated malleus allows easier and more stable placement of middle ear prostheses.