Perilymphatic Fistula Research Articles

Increased signal intensity with delayed post contrast 3D-FLAIR MRI sequence using constant flip angle and long repetition time for inner ear evaluation

PurposeThe purpose of this study was to compare the degree of perilymphatic enhancement between 4 hour post-contrast constant flip angle three-dimensional fluid attenuated inversion recovery (3D-FLAIR) images obtained with short repetition time (TR) and those obtained with long TR. Materials and methodsThis single-center, prospective study included patients who underwent MRI of the inner ear with heavily T2-weighted sequence, 3D-FLAIR sequence with a “short” TR of 10,000 ms (s3D-FLAIR) and with a “long” TR of 16,000 ms (l3D-FLAIR). Signal intensity ratio (SIR) and contrast-to-noise ratio (CNR) obtained with s3D-FLAIR and l3D-FLAIR were quantitatively assessed using region of interest (ROI) method and compared. The morphology of the endolymphatic space on both sequences was also evaluated. ResultsFrom March 2020 to July 2020, 20 consecutive patients were enrolled (9 women and 11 men; mean age, 52.1 ± 14.5 [SD] years; age range: 29–75 years). On l3D-FLAIR images, mean SIR (21.1 ± 8.8 [SD]; range: 7.6–46.1) was significantly greater than that on s3D-FLAIR images (15.7 ± 6.7 [SD]; range: 5.9–33.4) (P < 0.01). On l3D-FLAIR images, mean CNR (17 ± 8.5 [SD]; range: 2–40) was significantly greater than that on s3D-FLAIR images (12 ± 6.3 [SD]; range: 3.2–29.8) (P < 0.01). Kappa value for inter-rater agreement for endolymphatic hydrops, vestibular atelectasis and perilymphatic fistula were 0.93 (95% CI: 0.74–1), 1 (95% CI: 0.85–1) and 1 (95% CI: 0.85–1) respectively. ConclusionThis study demonstrates that the sensitivity of 3D-FLAIR sequences to low concentration gadolinium in the perilymphatic space is improved by elongation of the TR, with SIR and CNR increased by +34.4% and +41.3% respectively.

The Relationship Between the Third Window Abnormalities and Inner Ear Malformations in Children with Hearing Loss.

OBJECTIVE: To evaluate the relationship between the third window abnormalities and congenital inner ear malformations in pediatric patients with different types of hearing loss. If such a relationship should exist, it would be important to take it into account, in order to diagnose and treat pediatric hearing loss cases more accurately.Methods:Two hundred twenty-one children with hearing loss who had temporal bone computed tomography (CT) examination and were identified from 2013 to 2018 were retrospectively evaluated. The types of hearing loss were grouped as sensorineural hearing loss (SNHL), conductive hearing loss (CHL), and mixed hearing loss (MHL). Third window abnormalities included superior semicircular canal (SC) dehiscence, posterior SC dehiscence, enlarged vestibular aqueduct (EVA), X-linked stapes gusher, perilymph fistula, and bone dyscrasias. Congenital inner ear malformations included cochleovestibular, SC, and internal acoustic canal malformations. The relationships were analyzed with chi-square and Fisher’s exact tests.Results: In the study, 40 patients had unilateral hearing loss and 181 had bilateral hearing loss. In 402 ears, the rates of SNHL, CHL, and MHL were 88.5%, 6.9%, and 4.4%, respectively. EVA was the most common third window abnormality (41/402; 9.7%), and SC malformations were the most common inner ear malformations (53/402; 13.2%). In the SNHL group, superior and posterior SC dehiscence were associated with cochleovestibular malformations (P = .035 and.020, respectively). In the CHL group, there was a relationship between EVA and SC malformations (P = .041). No relationships were found in the MHL group. Conclusion: Third window abnormalities and congenital inner ear malformations may be encountered simultaneously in children with SNHL and CHL.

Transcanal endoscopic management of lateral semicircular canal fistula: preliminary experience.

Labyrinthine fistula is one of the most frequent complications of cholesteatoma (CHO), occurring in about 8% of cases in the literature. In about 90% of cases, it is located at the level of the lateral semicircular canal, and its clinical manifestation includes vertigo, nystagmus and positive Hennebert and Tullio signs. The management of lateral semicircular canal fistula (LSCF) secondary to CHO classically requires a retroauricular access by performing a canal wall-up (CWU) or canal wall-down (CWD) mastoidectomy. However, in case of a CHO confined to the tympanic cavity causing a LSCF on the ampullar arm, a transcanal exclusive endoscopic approach could be considered. The aim of this study is to describe the feasibility of a transcanal exclusive endoscopic approach in the management of a CHO confined to the tympanic cavity causing a LSCF on the ampullar arm. From January 2019 to December 2020, three patients with LSCF secondary to mesotympanic CHO underwent transcanal exclusive endoscopic ear surgery repair at the Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Italy. This technique was successfully employed to treat LSCF in all three cases and was planned as a two-stage surgery, performing ossiculoplasty after 12-18 months. Functional outcomes were also satisfactory: complete eradication of CHO, hearing preservation and complete resolution of symptoms. In case of a CHO confined to the tympanic cavity causing an LSCF on the ampullar arm, a transcanal exclusive endoscopic approach could be considered as a feasible and safe technique.

Peculiarities of clinical manifestations of perilymphatic fistulas and evaluation of the effectiveness of treatment in patients with middle ear cholesteatoma

By the analysis of the 410 histories of illnesses of patients in 38 (9,26 %) are set perilymphatic fistula of different localization. Clinical, radiological intraoperative differences and going are set near the choice of method reconstructively operation depending on the type of perilymphatic fistula. After motion the extensive is certain more aggressive perilymphatic fistula is widespread, especially in the cases of cholesteatoma destruction of bone wall of labyrinth and simultaneous adhesion with a membranous labyrinth. On the stage of preoperative diagnostics from data of КТ of temporal bones of perilymphatic fistula set for 21 (55,3 %) patients and determined almost for all patients with extensive widespread perilymphatic fistula (in 12 patients from 13) and in 9 patients with limit perilymphatic fistula. By the preoperative inspection the positive test of fistula was determined only in 7 % patients. After localization more often perilymphatic fistula was determined at the level of lateral semicircular canal – for 23 patients (60,5 %). Plural localization of perilymphatic fistula with the united defeat of bone wall two and more semicircular canals educed 5 patients (13,1 %). The open variant of tympanoplasty is executed in 30 patients (78,9 %). The closed variant of tympanoplasty is in 6 (15,8 %) patients. Early exposure of perilymphatic fistula after the presence of not staggered endost and in good time reconstructive surgical interference is conducted with optimal combined by microscopically-endoscopic visualization for patients with chronic otitis media with cholesteatome will allow saving a rumor and will prevent development of irreversible complications from the side of internal ear.

Challenges in managing complex chronic middle ear disease: MERF experience

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic otitis media is one of the commonest conditions managed in otolaryngology practice. In developing countries such as India, advanced disease presentation is often seen mostly owing to lack of awareness of the disease and its potential complications, long distance between the patient’s home and the treatment centre, causing delay in treatment. Surgical management is the mainstay of treatment of chronic otitis media.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The aim of this study was to retrospectively analyze the patients with complex chronic middle ear disease, who underwent tympanomastoid surgery. Forty-seven&lt;strong&gt; &lt;/strong&gt;patients (4.9%) out of a total of 968 patients with chronic otitis media presented with complex advanced disease and challenging intra-operative situations at our tertiary referral centre between January 2016 to December 2020. The extent of disease, associated complications, challenges in surgical management, and the eventual outcomes were studied in detail.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among&lt;strong&gt; &lt;/strong&gt;these forty-seven&lt;strong&gt; &lt;/strong&gt;patients, there were 24 males and 23 females. Of the 47 patients, 8 were children (17%). Extensive cholesteatoma causing facial palsy, labyrinthine fistula, dural involvement, internal auditory meatus involvement, extensive granulations extending into the inner ear through the oval or round window, extensive tympanosclerosis was noted in these patients. All patients underwent surgical management, and achieved satisfactory outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Advanced chronic otitis media has the potential to pose various challenges during tympanomastoid surgery. Appropriate planning for surgery aiming at complete disease clearance, meticulous after-care and long-term surveillance result in favorable outcomes.&lt;/p&gt;

Post-operative hearing among patients with labyrinthine fistula as a complication of cholesteatoma using “under water technique”

IntroductionDuring surgery in patients with labyrinthine fistula the mandatory complete removal of the cholesteatoma while preserving inner ear and vestibular function is a challenge. Options so far have been either the complete removal of the cholesteatoma or leaving the matrix on the fistula. We evaluated an alternative “under water” surgical technique for complete cholesteatoma resection, in terms of preservation of postoperative inner ear and vestibular function.MethodsFrom 2013 to 2019, 20 patients with labyrinthine fistula due to cholesteatoma were operated. We used the canal wall down approach and removal of matrix on the fistula was done as the last step during surgery using the “under water technique”. The pre and postoperative hearing tests and the vestibular function were retrospectively examined.ResultsThere was no significant difference between pre and post-operative bone conduction thresholds; 20% experienced an improvement of more than 10 dB, with none experiencing a postoperative worsening of sensorineural hearing loss. Among seven patients who presented with vertigo, two had transient vertigo postoperatively but eventually recovered.ConclusionOur data show that the “under water technique” for cholesteatoma removal at the labyrinthine fistula is a viable option in the preservation of inner ear function and facilitating complete cholesteatoma removal.

Two Cases of Idiopathic Progressive Sensorineural Hearing Loss with Positional Nystagmus in Postpartum Period: Possible Spontaneous Perilymph Fistula?

Perilymph fistula (PLF) is defined as an abnormal communication between the middle ear cavity and perilymphatic space of the inner ear. Most cases of PLF are responsible for pressure change caused by internal trauma or external trauma. However, spontaneous PLF might occur without an obvious history of barotrauma. We report two cases of possible spontaneous PLF in the postpartum period: both cases involved progressive sensorineural hearing loss with positional dizziness. Although the leakage of perilymph was not found during exploration, both hearing loss and dizziness improved immediately after PLF repair. It is necessary to consider the possibility of PLF in patients who have sudden or progressive sensorineural hearing loss with positional nystagmus. Early surgical exploration is recommended even if the history of barotrauma is not clear.

Underwater Endoscopic Ear Surgery for Closure of Cholesteatomatous Labyrinthine Fistula With Preservation of Auditory Function.

To analyze the outcomes of the underwater endoscopic ear surgery (UWEES) technique for closure of cholesteatomatous labyrinthine fistula (LF) with preservation of auditory function. Retrospective case review study. Tertiary referral center. A total of 12 patients with cholesteatomatous LF. Surgical method of closure using UWEES for cholesteatomatous LF to minimize inner ear damage. Artificial cerebrospinal fluid (CSF) was used as the perfusate, except for earlier cases when saline was employed. Comparison of bone conductance hearing level (BCHL) before and after surgery. A change of BCHL less than 10 dB was defined as successful preservation of bone conductance hearing. All cases of LF were treated successfully by closure using the UWEES technique. Seven cases were type I, one was type IIa, and four were type III according to the Milewski and Dornhoffer classification of LF. The average LF size was 3.1 mm (1-7 mm). Eleven patients were evaluated and their bone conductance hearing was well preserved in all of them (11/11). One patient was too young for preoperative evaluation of BCHL, but hearing preservation was verified 2 years later at the age of 6 years. Remarkably, none of the patients complained of vertigo, except for only a slight manifestation on postoperative day 1. The UWEES technique was effective for closure of cholesteatomatous LF with preservation of auditory function.

Vestibular Terminology and the Cause of Symptoms from a Chronic Perilymph Leak (Perilymph Fistula)

Vestibular Terminology and the Cause of Symptoms from a Chronic Perilymph Leak (Perilymph Fistula)

\u201cSandwich technique\u201d enables preservation of hearing and antivertiginous effect in cholesteatomatous labyrinthine fistula

PurposeThe aim of the study was to assess hearing, surgical and clinical results of the treatment in patients with cholesteatomatous labyrinthine fistula (LF) focusing on the different techniques and materials used in the management.MethodsStudy group included 465 patients. Cases with LFs discovered or confirmed during surgical procedure were thoroughly analyzed.ResultsLFs were noted in 11.4% of all cases. Thirty-eight patients, with all follow-up data available, were included into the further analysis. Most LFs were located in the lateral semicircular canal (87%). LFs were assessed as small in 2 cases, as medium in 24 patients while 12 were described as large. Based on Dornhoffer and Milewski classification, 50% of LFs were classified as IIa, 24% as IIb, 6 LFs were very deep (type III), while 4—superficial (type I). The size and type of LF did not influence postsurgical complaints (p = 0.1070, p = 0.3187, respectively). Vertigo was less frequent in LFs treated by “sandwich technique”, especially those with opened endosteum. In 30 (79%) patients, hearing improved or did not change after surgery. Hearing outcomes were significantly better in the ears operated by means of CWU technique (p = 0.0339), in LFs with intact membranous labyrinth (p = 0.0139) and when “sandwich technique” was performed (p = 0.0159). Postsurgical bone conduction thresholds levels were significantly better in LFs covered by “sandwich method” (p = 0.0440).Conclusion“Sandwich technique” (temporal fascia–bone pate–temporal fascia) enables preservation of hearing as well as antivertiginous effect in patients with cholesteatomatous labyrinthine fistula.

An Unusual Case of Non-Traumatic Perilymphatic Fistula with Acute Presentation

An Unusual Case of Non-Traumatic Perilymphatic Fistula with Acute Presentation

Fistulae of the Canal Lateral Due to Cholasteatomatous Otitis About 5 Cases

Our study is retrospective on 5 cases of fistulae of the lateral semi-circular duct (CSCL) complicating chronic cholesteatomatous otitis media, operated in the otolaryngology department of the CHU HASSAN II of Fez, over a period of 4 years from January 2014 to December 2017. The age of our patients ranged from 6 years to 65 years with a mean of 26 years, and a clear male predominance. The consultation period ranged from 1 year to 15 years. Othorrhea and vertigo were consistent in all our patients, combined with mixed deafness in 3 patients. The otoscopy revealed several aspects; going from image Typical a cholesteatoma of the middle ear with epidermal scales in the middle ear emerging from a perforation or a tympanic retraction pocket, or an attical cholesteatoma on a stage III retraction pocket. Ossicular lysis was evident in 3 of patients. Peripheral vestibular syndrome was noted in all of our patients. Neurological examination found a case of facial paralysis. Concerning the functional impairment; 2 of our patients had pure transmissive deafness, the remaining 03 patients had mixed deafness. Diagnosis labyrinthine fistulae has been clinically evoked and surgically confirmed. All our patients received preoperative CT scan. MRI has a complementary and fundamental role in the diagnosis of some internal ear disorders, it was requested in one patient. Treatment of fistulae (CSCL) was achieved by plugging the breach with temporal aponevrosis associated with the treatment of Chronic cholesteatomatous otitis. In our series, all our patients received general antibiotic therapy adapted to the antibiogram, 3 patients received treatment with open tympanoplasty wall down patients received tympanoplasty by closed technique. The surgical follow-ups were simple.

Labyrinthine fistula secondary to cholesteatoma: a video demonstration

Labyrinthine fistula is a defect of the bony labyrinth of the petrous portion of the temporal bone. This can proceed to involve the membranous labyrinth.[1][1] Causes include surgery, trauma, barotrauma,...

Vestibular disorders in children: A retrospective analysis of vestibular function test findings

ObjectiveThis study was designed to describe the most common vestibular disorders in children and their associated findings on vestibular function testing. MethodData from 203 children with a mean age of 11.16 ± 3.87 (range, 1–17) years were collected from among 3400 patients who underwent vestibular assessment at a vertigo center in a tertiary hospital over a 3-year period. A retrospective data analysis was performed for 203 children. ResultsVestibular disorders were diagnosed in 78.3% (n = 159) of 203 children among 3400 patients, which revealed a 3-year incidence of 4.67% in our study. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis in our group of children (49%; n = 100), which involved both primary BPPV, and secondary BPPV that was associated with other vestibular pathologies. Vestibular migraine (VM) was the second most common diagnosis (41%; n = 83) followed by benign paroxysmal vertigo of childhood (BPVC; 4.5%, n = 9), vestibular neuritis (VN; 4.5%, n = 9), and psychogenic vertigo (4.5%, n = 9). Our study showed that Meniere's Disease (MD; 1.5%, n = 3) and central vertigo (1.5%, n = 3) were less commonly diagnosed in children. Perilymphatic fistula (PLF) was diagnosed and surgically confirmed in only one child. ConclusionBPPV and VM were the most common pediatric vestibular disorders in our study. Clinicians should be aware of the prevalence, signs, and symptoms of the most common vestibular disorders in children to enable diagnosis, treatment, and rehabilitation. Vestibular function testing with age-appropriate adaptations results in improved differential diagnosis, which guides medical treatment and rehabilitation.

Double Trouble of Double Fistulae

The complications of attico-antral type of Chronic Suppurative Otitis Media (CSOM) are severe due to underlying bone erosion. We describe a case of a 40-year-old lady with attico-antral CSOM and mastoiditis with a postauricular fistula, who underwent modified radical mastoidectomy with excision of the postauricular cutaneous mastoid fistula. Interestingly, another fistula over the dome of lateral semicircular canal was noted intraoperatively.Few reports of occurrence of postauricular mastoid fistula with a labyrinthine fistula have been documented.

Selected Otologic Disorders Causing Dizziness.

This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease including Cogan syndrome. The recent data on modern imaging techniques with three-dimensional delayed IV contrast in Ménière disease, findings on the clinical and testing parameters to diagnose semicircular canal dehiscence and barotrauma, and clinical findings in Ramsay Hunt syndrome, cholesteatoma, and enlarged vestibular aqueduct syndrome are discussed in the article. The most recent findings on the treatment and evaluation of autoimmune inner ear disease and Cogan syndrome are also covered. This article discusses the common clinical otologic entities in patients who may present to the neurologist for vertigo, and it can be used as a guide in the diagnosis of these conditions with the use of auditory, vestibular, and imaging results.

Complete recovery of delay of p13 latency in the cervical vestibular evoked myogenic potentials of a patient with earpick-induced inner ear injury

Abstract Introduction: Cervical vestibular evoked myogenic potentials (cVEMP) testing is a vestibular function test for evaluating the saccular and inferior vestibular nerve function. The diagnostic value of p13 latency on the cVEMP in inner ear disorders is still unknown. Patients concerns: When a 21-year-old man was removing earwax from his right ear with an earpick, his girlfriend accidentally bumped against him. Immediately thereafter, he noticed right otalgia, right hearing loss and vertiginous attack with vomiting. Diagnosis: The patient showed a perforation in his right eardrum and spontaneous nystagmus directed to the left, indicating right perilymphatic fistula caused by the earpick injury. Interventions: cVEMP, caloric test and audiometry were repeated from 2 to 28 months after the injury. Outcomes: One month after the injury, the perforation of the tympanic membrane had closed, and the fistula test was negative. Two months after the injury, he had no spontaneous nystagmus. Four months after the injury, delay of p13 latency in the affected ear was observed on the cVEMP, but at 10 months after the injury, the p13 delay had disappeared and was normal. Although the patient's hearing level was normal at 2 months after the injury, severe semicircular canal dysfunction existed in the affected ear, and remained unchanged up to 28 months after the injury. Conclusion: We report the first case of a complete recovery of the delay of p13 latency in the cVEMP caused by an inner ear injury. Delay of p13 latency on the cVEMP has been used to diagnose retrolabyrinthine disorders. Not only asymmetric p13-n23 amplitude but also delay of p13 latency could be sensitive tools for diagnosing unilateral saccular dysfunction.

Audiologic Outcomes After Oval and Round Window Reinforcement Surgery.

Oval window (OW) and round window (RW) reinforcement surgery has been used for symptomatic treatment of multiple clinical entities, most commonly perilymphatic fistula and superior semicircular canal dehiscence. Owing to the theoretical acoustically negative effect of stiffening the windows, there has been concern of an unfavorable effect on audiologic outcomes due to the procedure. The purpose of this study is to specifically evaluate audiologic outcomes after OW and RW reinforcement. A retrospective review of patients undergoing transcanal OW or RW reinforcement was completed. Patients were evaluated both as a total group and as two groups separated into "third window" and "two-window" groups based on their specific diagnosis. Primary outcomes included changes in individual pure-tone thresholds, pure-tone average (PTA), air-bone gap, speech reception threshold (SRT), and word recognition scores (WRS) between the preoperative and postoperative groups. Seventy-one patients were included in the study. The combined cohort demonstrated a significant postoperative 2.75 dB increase in the air conduction hearing level at 4000 Hz (p < 0.05). This was almost entirely accounted for by a 2.18 dB increase in the air-bone gap at this frequency (p < 0.05). There were no significant changes in PTA, SRT, or WRS between in the combined group or in the subgroup analysis. OW and RW tissue reinforcement resulted in a statistically significant but likely clinically insignificant decrease in hearing at the 4000 Hz frequency. There was no worsening of PTA, WRS, or SRT.

Significance of Pseudo-Conductive Hearing Loss and Positional Nystagmus for Perilymphatic Fistula: Are They Related to Third-Window Effects?

ObjectivesPatients’ clinical presentation is critical for identifying suspected perilymphatic fistula (PLF). The involvement of third-window lesions in the pathomechanism of PLF has been hypothesized. This study investigated the clinical features of PLF and the relationship of the third-window effect with PLF. MethodsSixty patients underwent surgical exploration for suspected PLF and the oval and round windows were reinforced. Clinical features including demographics, pure-tone audiometry (PTA), and videonystagmography were evaluated preoperatively and 1 month postoperatively. Surgical outcomes were analyzed according to the improvement of hearing and vestibular symptoms and signs. The conductive components of PTA (air-bone gap [ABG]) were measured, and the relationship between ABG closure after surgery and hearing improvement was analyzed. In addition, postoperative subjective dizziness was assessed by clinical interviews. Changes in positional nystagmus were analyzed according to ABG closure and hearing improvement.ResultsABG at lower frequencies (LFABG; 250 Hz, 500 Hz, 1,000 Hz) was present in 27 patients (45%). Postoperatively, PTA significantly improved after surgical repair. Among the patients with preoperative LFABG (n=27), 15 (55.5%) showed postoperative ABG closure and significant improvement in PTA at all frequencies compared with the patients without ABG closure (P=0.012). Subjective dizziness improved in 57 patients (93.3%). Positional nystagmus was found in 45 of 49 patients. Multiple canal involvement was more common than single canal involvement (67% vs. 33%). The horizontal semicircular canal was most commonly involved, followed by the posterior and anterior canals. Postoperatively, positional nystagmus disappeared, or the number of involved canals decreased in 22 of 34 patients (64.7%). ConclusionPseudo-conductive hearing loss at lower frequencies and positional nystagmus originating from multiple semicircular canals were common findings in PLF. Surgical reinforcement of the oval and round windows improved the hearing threshold accompanied by closure of ABG. A third-window lesion might explain these clinical features of PLF.

Новый метод хирургического лечения пациентов с врожденной аплазией окна преддверия

Aplasia of the oval window is an extremely rare developmental anomaly of the middle ear. Previously, many authors proposed various methods of surgical treatment of this pathology, but in most cases it was not possible to achieve a stable satisfactory functional result. At this stage, an idea was formed about the main reason for the unsatisfactory results, namely, the overgrowth of the formed vestibulostomy, which is accompanied by fixation of the prosthesis. The solution of this problem is one of the priority tasks of surgery for malformations of the middle ear at this stage. This paper presents a new developed and patented method of surgical treatment of patients with congenital aplasia of the vestibule window. The method consists in modeling a complex titanium prosthesis, consisting of an f-element and an m-element. The f-element is installed in the neo-oval window and has the function of a protector that prevents fixation of the prosthesis as a result of bone-cicatricial obliteration processes. Further, the plunger part of the f-element is installed in the m-element. The developed method of stapes prosthetics in case of anomalies in the development of the vestibule window, based on the results of this study, has proven its high efficiency. Installation of a modified endo-lymphatic shunt into the formed neo-oval window, pressing the fascial flap previously placed on the neo-oval window, followed by the insertion of the K-piston prosthesis, prevents overgrowing of the neo-oval window in the postoperative period, prevents the development of fixation of the prosthesis and prevents the development of perilymphatic fistula. A comparative assessment of the effectiveness of the proposed method and method with the formation of a neo-oval window and the installation of a stapedial prosthesis (as in piston stapedoplasty) was carried out. The effectiveness of the developed method has been proven – 89% of the functional efficiency in the long-term postoperative period, which is close to the indicators of the effectiveness of piston stapedoplasty in otosclerosis (the frequency of a stable satisfactory functional result when performing piston stapedoplasty in otosclerosis is about 95%).