Description
Case I
Case II
Case III


Description 

Ossicular chain damage appears most often as a result of chronic inflammation of the middle ear. Other causes include ear injuries. In chronic otitis media most frequent site of damage of the ossicles is the long process of the incus and the incudostapedial  joint. In these cases usually coexists tympanic membrane perforation. Injuries most commonly cause damage to the joint itself and to the stapes. The main symptom of ossicular chain damage is hearing loss. It may be accompanied by tinnitus and ear discharge. It should be noted, however, that in some cases of ossicular chain damage hearing may remain normal. In general, the basic method of treatment of ossicular chain damage is surgery. The procedure is called ossiculoplasty and its purpose is to restore the continuity of the ossicular chain using ossicular chain remnants or artificial passive middle ear implants.


Case I

Picture below: this is a picture of chronic otitis media with destruction of the tympanic membrane in posterior quadrant and initial destruction of the ossicles. 11-year-old child, left ear. The tympanic membrane is atrophic, pulled in the posterior quadrant and creates shallow retraction pocket. The atrophic segment is stuck to the long process of the incus and incudostapedial joint. One can notice hypervascularity along the handle of malleus. The mobility of the tympanic membrane was restricted in otoscopy. This is the image of intermediate, chronic otitis media (fig. 1 and 2a).

The child had only moderate symptoms – plugged ear during upper respiratory tract infections. Hearing was almost normal, there was no ear discharge. The diagnosis was raised during a routine examination.

Destruction of the ossicles
Fig. 1 Destruction of the ossicles
Destruction of the ossicles – scheme
Fig. 1a Destruction of the ossicles – scheme
  1. handle of malleus
  2. umbo
  3. stapes
  4. incus long process
  5. early stage of destruction of the incudostapedial joint
  6. dotted line – retraction pocket in posterior quadrant
  • Because there was evident destruction of the tympanic membrane and ossicular chain damage, we made the decision of surgical treatment.
  • Range of surgical intervention: myringoplasty with tragus perichondrium, stabilisation of incudostapedial joint by small portion of tragus cartilage.
  • There was no need to use artificial prostheses because it was initial stage of destruction of the ossicles and their continuity was preserved.

Case II

Pictures below: most important steps during ear operation with reconstruction of the tympanic membrane and ossicles (myringoplasty and ossiculoplasty). 10-year-old child, left ear.

Chronic otitis media with destruction of tympanic membrane and ossicular chain
Fig. 2 Chronic otitis media with destruction of tympanic membrane and ossicular chain
Chronic otitis media with destruction of tympanic membrane and ossicular chain - with description
Fig. 2a Chronic otitis media with destruction of tympanic membrane and ossicular chain – with description
  1. handle of malleus
  2. destruction of the tympanic membrane, strong fibrous adhesion with head of the stapes
  3. postero – inferior part of the tympanic membrane
  4. level of the stapes
  5. level of the long process of the incus
Opened tympanic cavity
Fig. 3 Opened tympanic cavity
Opened tympanic cavity - with description
Fig. 3a Opened tympanic cavity – with description
  1. long process of the incus
  2. head of the stapes
  3. promontory
  4. chorda tympani
  5. facial nerve
  6. tendon of the stapedial muscle
  7. yellow arrow – destruction of the long process of the incus
Harvesting of the perichondrium
Fig. 4 Harvesting of the perichondrium
Harvesting of the perichondrium - with description
Fig. 4a Harvesting of the perichondrium – with description
  1. cartilage
  2. perichondrim
  3. skin of the tragus
Fragment of perichondrium
Fig. 5 Fragment of perichondrium
Removed and prepared incus
Fig. 6 Removed and prepared incus
Removed and prepared incus - with description
Fig. 6a Removed and prepared incus – with description
  1. body of the incus
  2. drilled pan for the head of the stapes
Tympanic cavity after ossiculoplasty
Fig. 7 Tympanic cavity after ossiculoplasty
Tympanic cavity after ossiculoplasty - with description
Fig. 7a Tympanic cavity after ossiculoplasty – with description
  1. tympanomeatal flap
  2. incus placed on the head of stapes and under malleus (interposition)
  3. promontory
  4. facial nerve
  5. chorda tympani
  6. tendon of the stapedial muscle
Final stage of operation
Fig. 8 Final stage of the operation
Final stage of the operation - with description
Fig. 8a Final stage of the operation – with description
  1. handle of the malleus
  2. umbo
  3. perichondrium used for myringoplasty – ear is closed