Sanjaya Koirala* and Krishna Bogati

Department of ENT-HNS, Tribhuvan University/Gandaki Medical College, Nepal

*Corresponding Author: Sanjaya Koirala, Department of ENT-HNS, Tribhuvan University/Gandaki Medical College, Nepal.

Received: May 20, 2024; Published: July 22, 2024

Abstract

Introduction: Complete absence of malleus with intact and normal looking incus and stapes in a case of subtotal perforation of tympanic membrane is a rare phenomenon not seen before in my experience of 7 years of ear surgery and not even reported before in any literature till date.

Case: Twenty-eight years old female patient presented with history of recurrent ear discharge with decreased hearing for last 3 years. On examination she had subtotal perforation with absent normal landmarks. She underwent tympanoplasty with ossiculoplasty. During surgery she was found to have missing malleus with completely normal looking incus and stapes. Indudostapedial joint was intact and mobile. She gave history of iatrogenic trauma to the same ear in form of syringing and curretage for ear wax in a tertiary hospital 3 years ago, duration similar to her symptoms.

Discussion: Malleus is the last ossicle to undergo necrosis by chronic otitis media. TM perforations are seen sometimes but complete removal of malleus during routine otologic outpatient procedure is rare but not inevitable. In the case presented, iatrogenic trauma only best explains the complete absence of malleus. This demands meticulousness in every procedures we perform daily however trivial it may sound.

Keywords: Malleus; Tympanoplasty; Ossiculoplasty

References

1. Silverstein H., et al. “Mixed hearing loss in iatrogenic tympanic membrane perforations over the round window niche and the immediate effect of paper patch myringoplasty”. Audiology and Neurotology3 (2012): 155-160.
2. Sheikh R., et al. “Preoperative Predictors in Chronic Suppurative Otitis Media for Ossicular Chain Discontinuity: A Cross Sectional Study”. Audiology and Neurotology4 (2016): 231-236.
3. Bedri EH and Redleaf M. “Ossicular Chain Reconstruction in a Developing Country”. Annals of Otology, Rhinology and Laryngology5 (2018): 306-311.
4. Akarcay M., et al. “Ossicular chain erosion in chronic otitis media patients with cholesteatoma or granulation tissue or without those: analysis of 915 cases”. European Archives of Otorhinolaryngology5 (2019): 1301-1305.

Citation

Citation: Sanjaya Koirala and Krishna Bogati. “An Unusual Case of Complete Absence of Malleus with Intact Incus and Stapes in Subtotal Perforation with History of Iatrogenic Trauma".Acta Scientific Otolaryngology 6.8 (2024): 32-33.

Copyright

Copyright: © 2024 Sanjaya Koirala and Krishna Bogati. 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.