Tympanoplasty Type IV Using a Teflon-wire Piston in a Case with Unintentionally Mobilized Footplate during Surgery for Otosclerosis

Abstract

A 47-year-old woman with diagnosis of otosclerosis in her left ear underwent small fenestra stapedotomy in our clinic. During surgery, after incising the crura of the stapes, the stapes footplate became movable. Considering the risk of sensorineural hearing loss, we chose tympanoplasty type IV by placing a piece of temporalis fascia on the footplate and a shortened teflon-wire piston between the incus and the footplate, rather than stapedectomy. Now 9 months after surgery, she is taking an uneventful course, and the air-bone gap of her left ear has been reduced from 26.6dB to 3.3dB. The stapes not infrequently is fractured or becomes movable during surgery for otosclerosis in Japan, probably because the sclerotic change of the stapes is generally mild in the Japanese population. In order to avoid the risk of sensorineural hearing loss due to perilymph leakage by floating stapes or stapedectomy, the method that we used in the present case was considered one of the good options in such cases, although recurrence of hearing loss due to refixation of the stapes is possible in the future.