Maintain Ossicular Chain Intact

The stapes may be partially obscured because of the contracted middle ear space, the malformed lateral ossicular mass, and/or the overlying facial nerve. Usually, enough of the stapes can be seen to assess its mobility and the integrity of the incudostapedial joint. The lateral ossicular mass is maintained in position and not removed to obtain a better view of the stapes. In most cases, the ossicular chain, although deformed, is mobile. Hearing results may be better when the chain is left intact, instead of interposing a prosthesis or autograft material.13 Prostheses are vulnerable to fixation because of the small size of the middle ear space and the reduced clearance between them and the bony walls of the tympanum.

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