Sumit Sharma¹*, Rashmi Nambiar², Ahmad Aseem Nadeem³, Sanyukta Chakravarty², Mahesh Mishra², B.P. Singh⁴ and Suvarna Sharma⁵

¹Professor and Head, Department of E.N.T, Mayo Institute of Medical Sciences, Barabanki, Utter Pradesh, India
²PG-Junior Resident Third Year, Department of E.N.T, Mayo Institute of Medical Sciences, Barabanki, Utter Pradesh, India
³Assistant Professor, Department of E.N.T, Mayo Institute of Medical Sciences, Barabanki, Utter Pradesh, India
⁴Professor, Department of E.N.T, Mayo Institute of Medical Sciences, Barabanki, Utter Pradesh, India
⁵Intern, KMC Manipal, India

*Corresponding Author: Sumit Sharma, Professor and Head, Department of E.N.T, Mayo Institute of Medical Sciences, Barabanki, Utter Pradesh, India.

Received: August 01, 2023; Published: September 19, 2023

Abstract

Introduction: With 9 indexed reports absence of stapedius muscle and its tendon contributes to a rare congenital anomaly. Patient with this condition present with non progressive conductive hearing loss on pure tone audiometry but the condition cannot be diagnosed with PTA or even HRCT temporal bone.

Discussion: Thus it becomes one of the differential diagnoses for conductive hearing loss with unremarkable tympanic membrane. Diagnosis can be made only via performing exploratory tympanotomy or during tympanomastoid surgery in cases with perforated tympanic membrane it can co exist with certain acquired or genetic conditions of middle or inner ear. Lack of standardized or evidence based protocol make its diagnosis challenging. The theory behind its origin is absence or regression of separation of cranial mesenchyme of second pharyngeal arch (stapedial anlage) from reichert’s cartilage. Here, we present a case of 14-year-old female with congenital absence of stapedius muscle and tendon. She presented with congenital, right sided ear discharge, non progressive, moderate conductive hearing loss, and was diagnosed with this condition at surgery. She underwent type 1 tympanoplasty and was diagnosed incidentally during surgery. The Ossicular chain and round window reflex was intact. Apart from the clinical presentation and its management, the present report also emphasises the plausible theories on relevant embryology explaining such an unusual event.

Conclusion: Awareness of variation of this type is important for surgeons specially while operating for Ossicular chain fixation or discontinuity.

 Keywords: Exploratory Tympanotomy; Congenital Middle Ear Anomalies; Hearing Reconstruction; Reichert’s Cartilage; Stapedial Anlage

References

1. Scott-Brown WG., et al. “Congenital middle ear abnormalities”. In: Scott-Brown's Otorhinolaryngology: Head and Neck Surgery. eighth. Boca Raton: CRC Press (2019): 107.
2. Herman HK and Kimmelman CP. “Congenital anomalies limited to the middle ear”. Otolaryngology–Head and Neck Surgery 106 (1992): 285-287.
3. Reiber ME and Schwaber MK. “Congenital absence of stapes and facial nerve dehiscence”. Otolaryngology–Head and Neck Surgery 116 (1997): 278.
4. Williams PL., et al. “Gray’s Anatomy”. 38^th New York: Churchill Livingston Publishers (1995): 263, 284, 1375-1376.
5. Causse JB., et al. “Stapedius tendon reconstruction during stapedotomy: Technique and results”. Ear Nose and Throat Journal 76 (1997): 256-8, 260-269.
6. Abdul-Baqi KJ. “Objective high-frequency tinnitus of middle-ear myoclonus”. Journal of Laryngology and Otology 118 (2004): 231-233.
7. Wynsberghe DV., et al. “The senses”. In: Human Anatomy and Physiology. 3^rd New York: McGraw-Hill Inc.; (1995): 512.
8. Hough JV. “Congenital malformations of the middle ear”. Archives of Otolaryngology 78 (1963): 335-343.
9. Kurosaki Y., et al. “Congenital ossification of the stapedius tendon: Diagnosis with CT”. Radiology 195 (1995): 711-714.
10. Hoshino T and Paparella MM. “Middle ear muscle anomalies”. Archives of Otolaryngology 94 (1971): 235-239.
11. Hough JV. “Malformations and anatomical variations seen in the middle ear during the operation for mobilization of the stapes”. Laryngoscope 68 (1958): 1337-1379.
12. Schuknecht HF and Gulya AJ. “Anatomy of the Temporal Bone with Surgical Implications”. Philadelphia, PA: Lea-Febiger; (1986): 240-269.
13. Teunissen EB and Cremers WR. “Classification of congenital middle ear anomalies. Report on 144 ears”. Annals of Otology, Rhinology, and Laryngology8 Pt 1 (1993): 606-612.
14. Magnuson T and Har-El G. “Middle ear anomalies”. Otolaryngology–Head and Neck Surgery 111 (1994): 853-854.
15. Kanona H., et al. “A rare stapes abnormality”. Case Reports in Otolaryngology 2015 (2015): 387642.
16. Dutta M. “The ectopic accessory parotid system with congenital cheek fistula: An overview and current update”. Laryngoscope 6 (2017): 1351-1360.
17. Patel PK., et al. “Head and neck embryology” (2021).
18. Rodríguez-Vázquez JF., et al. “Development of stapedius muscle and unilateral agenesia of the tendon of the stapedius muscle in a human fetus”. Anatomical Record (Hoboken)1 (2010): 25-31.
19. Rodríguez-Vázquez JF. “Development of the stapes and associated structures in human embryos”. Journal of Anatomy 207 (2005): 165-177.
20. Brask T. “The noise protection effect of the stapedius reflex”. Acta Otolaryngology 360 (1979): 116-117.
21. Dalmia D and Behera SK. Congenital absence of stapedius muscle and tendon: Rare finding in two cases”. Indian Journal of Otology 23 (2017): 43-45.

Citation

Citation: Sumit Sharma., et al. “Congenital Absence of Stapedial Tendon and Pyramidal Eminence - Incidental Finding During Tympanoplasty - A Rare Entity".Acta Scientific Otolaryngology 5.10 (2023): 47-50.

Copyright

Copyright: © 2023 Sumit Sharma., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.