Abstract
A 34-year-old woman had bilateral slight hearing loss at her junior or junior high school days. She complained of gradual progressive hearing loss within a couple of days and got to feel handicaps especially in her left ear during her working activity.
In our hospital, her bilateral tympanic membranes appeared intact, and tympanometry and stapedial reflex test were within normal level. CT scanning revealed no remarkable findings. Pure tone audiometry and speech discrimination test demonstrated bilateral moderate mixed hearing loss. We made a decision to try expiratory tympanotomy in her left worse hearing ear under local anesthesia.
After fore-auricular incision, the tympano-meatal flap was lifted. Without any damage to chorda tympani, we observed a loose incudo-stapedial joint in the tympanic cavity. The mobility of stapes was not so bad. We made a decision to try ossicular chain reconstruction using a small piece of cortical bone and connective tissues, and inserted into small lacks in the incudo-stapedial joint as Tympanoplasty IIIi-I. We could get good hearing result 6 month after surgery. In the next year, we also performed the same surgery in her right ear and then could get the similar good hearing result. We would like to discuss about differential diagnosis and surgical strategy in the present case.
