Process Of Incus Research Articles

Ossicular status in patients operated for chronic suppurative otitis media

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharge through a tympanic perforation. The WHO has classified India as a country with highest prevalence ( > 4%) requiring urgent attention to deal with a massive public health problem. CSOM is often associated with a bone eroding process which occurs due to the presence of cholesteotoma, granulation tissue or both. Methods: This study was conducted in a department of E.N.T, Yenepoya Medical College Hospital, Deralakatte, Mangalore for a period of 2 years. This study was conducted to evaluate the ossicular involvement in chronic suppurative otitis media (CSOM). A retrospective-prospective study was conducted over a 2-year period on 86 patients who underwent surgery for the disease. Demography, ossicular status and hearing loss were studied and analyzed using SPSS programme. Results: The study revealed Tubotympanic disease was the more common type of disease. Ossicular necrosis was present in 35% of population. The most common ossicles involved were the whole of incus, followed by lenticular process and long process of incus. There was a higher incidence of ossicular disruption in atticoantral disease than in tubotympanic disease.

Numerical evaluation of implantable hearing devices using a finite element model of human ear considering viscoelastic properties.

Finite element method was employed in this study to analyze the change in performance of implantable hearing devices due to the consideration of soft tissues' viscoelasticity. An integrated finite element model of human ear including the external ear, middle ear and inner ear was first developed via reverse engineering and analyzed by acoustic-structure-fluid coupling. Viscoelastic properties of soft tissues in the middle ear were taken into consideration in this model. The model-derived dynamic responses including middle ear and cochlea functions showed a better agreement with experimental data at high frequencies above 3000 Hz than the Rayleigh-type damping. On this basis, a coupled finite element model consisting of the human ear and a piezoelectric actuator attached to the long process of incus was further constructed. Based on the electromechanical coupling analysis, equivalent sound pressure and power consumption of the actuator corresponding to viscoelasticity and Rayleigh damping were calculated using this model. The analytical results showed that the implant performance of the actuator evaluated using a finite element model considering viscoelastic properties gives a lower output above about 3 kHz than does Rayleigh damping model. Finite element model considering viscoelastic properties was more accurate to numerically evaluate implantable hearing devices.

Anatomical Variation-Notch in Long Process of Incus Due to Chorda Tympani Nerve in Two Cases

Introduction: The chorda tympani nerve takes origin from the mastoid portion of the facial nerve.Then it separates from the main trunk of facial nerve approximately 4 mm proximal to the stylomastoid foramen.Among the three ear ossicles present in middle ear, Incus is most stable ossicle showing least number morphological variation. Our aim is to describe a rare anatomical variation of incus i.e. a notch in the long process of incus which fits the chorda tympani nerve. This study will help otologic surgeons while performing operative procedures in a better way by understanding the anatomical details of middle ear and preventing chorda tympani nerve to iatrogenic trauma. Method: We performed 1500 tymapnoplasties and tympanomastoid surgeries and about 500 exploratory tympanotomies for last 10 years for various otological problems in our institution Dr BAM Central Railway Hospital. Any morphological variations were noted during surgeries. Case report: We found a rare anatomical variation of chorda tympani nerve in two cases where the nerve was found to be buried into the long process of Incus. Out of different middle ear surgeries we performed in last 10 years, Incus had minimum morphological variations in the ossicles. Although there are few studies which shows the presence of notch in the short process of incus but no study shows presence of notch in long process of incus so far. Conclusion: The knowledge of these anatomical variations of incus and course of chorda tympani will help in dealing with difficulties encountered during performing the surgical procedures and thereby it will help to preserve chorda tympani nerve.

OSSICULAR STATUS IN CHOLESTEATOMA : A DEPARTMENTAL EXPERIENCE IN A STATE MEDICAL COLLEGE OF WESTBENGAL.

Introduction: Chronic otitis media is a long standing infection of part or whole of middle ear cleft. Its active squamosal variant (cholesteatoma) is most dangerous due to its bone eroding property.
 Aims & Objective: Background knowledge of ossicular status in cholesteatoma will help us in determining the type of reconstruction needed during the surgery.
 Material & methods: 60 cases of cholesteama, irrespective of age and sex [diagnosed on the basis of clinical examination , audiological and radiological evaluation] were selected during the study period of two years and their ossicular status were recorded intra-operatively.
 Results & analysis: Ossicles and their parts getting involved in cholesteatoma cases , in decreasing order are :
 Lenticular process (in total 50 cases)>Long process of incus (in total 49 cases) > stapes super-structure(in total 29 cases) > body of incus(in total 26 cases)> head of malleus(in total 23 cases)> handle of malleus(in total 10 cases).
 Ossicular chain defeact in decreasing order are : M-I-S- > M+I-S- > M-I-S+ > M+I-S+.
 Conclusion: In our study it was found that incus is the most vulnerable ossicle to get involved in cases of active squamosal variety of chronic otitis media where as malleus appeared to be the least susceptible one.

Design-Dependent Calculation of the Prosthesis Length in Malleostapedotomy.

The results of a recently published micro-CT study suggested a correlation of the distance between long incus process and stapes footplate and the required prosthesis length in malleostapedotomy. The goal of this study was to test the reliability of that assumption. Rectangular and bent prostheses were tested in 11 cadaveric human temporal bone specimens; 1 of them showed a stapedial artery. Prosthesis length was calculated based on the distance between long incus process and stapes footplate. The rate of acceptable prosthesis insertion into the vestibule was investigated. In both prostheses designs, the insertion depth into the vestibule did not exceed 1.0 mm. Two prostheses did not pass the footplate level in bent prostheses (18%) and 1 in rectangular prostheses (9%). A rough estimation of the required prosthesis length in malleostapedotomy seems possible if the distance between long incus process and stapes footplate is known and a design-dependent equation exists.

The distance between stapedial footplate and incus in otosclerosis surgery

BackgroundThe measurement of the piston length during stapedotomy is important and it may have significant effects on the surgical outcome. ObjectiveTo determine the piston length in a group of otosclerosis patients who underwent primary stapedotomy. Material and methodsBetween Sep 2013 and Sep 2014, 85 patients with diagnosed otosclerosis underwent primary stapedotomy. Teflon prosthesis of 0.6 mm of diameter was used in all patients. The distance between medial surface of the long process of incus and center point of the stapedial footplate measured. The piston length calculated by adding 0.25 mm for the thickness of footplate and 0.50 mm for placement of the prosthesis into the vestibule. ResultsThe distance between stapedial foot plate and incus ranged from 3.50 to 4.50 mm. The mean distance was 3.95 ± 0.16 mm. In majority of cases (74.1%) piston length was 4.75 mm followed by 4.50 mm in 15.3% and 5.00 mm in 5.9%. Piston length was 4.25 mm in 3.5% and 5.25 mm in only 1.2% of patients. There was no significant post-operative complication and air bone gap closure obtained in all patients. ConclusionThe most common distance between foot plate and incus is 4.00 mm. No case needed a piston longer than 5.25 mm or shorter than 4.25 mm.

Reinforced active middle ear implant fixation in incus vibroplasty.

The active middle ear implant Vibrant Soundbridge® was originally designed to treat mild-to-severe sensorineural hearing losses. The floating mass transducer (FMT) is crimped onto the long incus process. The procedure is termed incus vibroplasty to distinguish from other attachment sites or stimulus modi for treating conductive and mixed hearing losses. Rare but possible complications are difficult incus anatomy, necrosis of the long incus process, secondary detachment, and loosening of the FMT with concomitant amplification loss. The aim of this study was to functionally evaluate reinforcement of the standard attachment of the FMT to the long incus process. The head of a Soft CliP® stapes prosthesis was used for reinforcement. Functional evaluation was performed in temporal-bone preparations and in clinical practice. A subtotal mastoidectomy and a posterior tympanotomy were performed in ten fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane, respectively, were measured by laser Doppler vibrometer (LDV). FMT-induced vibration responses of the stapes and RW were then measured for standard attachment and attachment reinforced with the head of a Soft CliP® stapes prosthesis. Additionally, the outcome in two groups of patients with incus vibroplasty using standard and the reinforced FMT attachment were compared. Eleven patients were treated by standard coupling; nine patients obtained reinforcement with the head of the Soft CliP® stapes prosthesis. Three to six months postoperatively, auditory thresholds for frequency-modulated (warble) tones and vibroplasty thresholds for pure tones were measured. In temporal bone, laser Doppler vibrometer measurements showed significantly enhanced vibration amplitudes of the stapes footplate and the RW membrane for the reinforced attachment compared with those for the standard attachment (on average, 5-10 dB at frequencies below 1 kHz and above 4 kHz). Interindividual amplitude variations were also smaller for reinforced attachment (on average, the standard deviation was 4-7 dB smaller). The clinical data showed lower vibroplasty thresholds for reinforced attachment compared with standard attachment, which amounted to, on average, 16 dB at 500 Hz and 12 dB at 4 kHz. Auxiliary fixation of the FMT by reinforcing the attachment to the long incus process, in these experiments with the head of a Soft CliP stapes prosthesis, leads to enhanced mechanical and functional coupling, evidenced by lower vibroplasty thresholds and increased bandwidth together with reduced variability of the vibrational frequency responses of the stapes footplate and RW membrane.

Use of incus as an interposition graft in ossiculoplasty for type IIb tympanoplasty

Background: In cases of chronic suppurative otitis media, the most common cause for the discontinuity in the ossicular chain is erosion of lenticular or long process of incus. To study hearing results, sequel and complications of using autologous incus as interposition graft in type IIb osiculoplasty. Methods: We studied 30 patients who required ossiculoplasty using autologous incus. The pre-operative audiograms were done. Post operatively patients were followed up to 2 years during which complete otological examination with audiogram was done. Results: According to the American Academy of Otolaryngology-Head and Neck Surgery guidelines, a successful hearing result is the one with post-operative air-bone gap of 20 decibels or less. Hence, by this standard our success rate is 77 percent and in all of our patients we have air-bone gap closure to below 30 decibles. Average closure in air-bone gap (gain) in our patients is 25.9 decibles with average pre-operative and post-operative air-bone gap being 47.70 decibles and 16.9 decibles there was no extrusion of incus. 3 patients had residual perforation and 2 patients had retracted grafts. All the patients with retracted grafts or residual perforation had oedematous middle ear mucosa and Eustachian tube dysfunction and high MER index. Conclusions: Autologous incus is an excellent interposition graft for ossiculoplasty. There is no risk of transmission of disease and no extra cost involved. Higher values of Middle Ear Risk Index, oedematous middle ear mucosa and Eustachian tube dysfunction are poor prognostic factor for success of ossiculoplasty.

Vibro-EAS: a proposal for electroacoustic stimulation.

In situ evaluation of the vibration performance of a hybrid system for intracochlear fluid stimulation, constructed from a floating mass transducer (FMT) coupled to an electric acoustic stimulation (EAS) cochlea implant (CI) electrode. EAS uses both CI technology to restore severe-to-profound hearing loss at high frequencies and acoustic amplification for mild-to-moderate hearing loss in the low-to-mid frequency range. More patients with residual hearing are becoming candidates for EAS surgery because of the improved techniques for hearing preservation. Most patients with partial deafness fulfill the audiological criteria at low and mid-frequencies for the active middle-ear implant with FMT (VSB). The FMT of the VSB is a potential device for acoustical stimulation in EAS. In seven fresh human temporal bones, stapes amplitude responses for fixation of a FMT to the long incus process (standard coupling) was compared with those for FMT fixation to a 20-mm inserted standard cochlea electrode array (31.5 mm) via the round window (Vibro-EAS). Vibration of the stapes footplate was measured by laser Doppler vibrometry. For 0.316 Vrms drive voltage, stimulation of the intracochlear fluid using a FMT-driven CI electrode (Vibro-EAS) yielded stapes amplitude responses comparable to those for acoustic stimulation with 84 dB SPL. These amplitude responses are 30 to 42 dB lower at frequencies up to 4 kHz than those for VSB standard coupling. Intracochlear combined electrical and mechanical stimulation may be a viable technique for electroacoustic stimulation. A reliable technique for attachment or integration of the FMT to the cochlea electrode array has yet to be developed.

HRCT Correlation with Round Window Identification during Cochlear Implantation in Children.

Objective:To determine the accuracy of High Resolution Computer Tomography (HRCT) temporal bone measurements in predicting the actual visualization of round window niche as viewed through posterior tympanotomy (i.e. facial recess).Materials and Methods:This is a prospective study of 37 cochlear implant candidates, aged between 1and 6 years, who were referred for HRCT temporal bone during the period December 2013 to July 2014. Cochlear implantation was done in 37 children (25 in the right ear and 12 in the left ear). The distance between the short process of incus and the round window niche and the distance between the oval window and the round window niche were measured preoperatively on sub-millimeter (0.7 mm) HRCT images. We classified the visibility of round window niche based on the surgical view (i.e. through posterior tympanotomy) during surgery into three types: 1) Type 1- fully visible, 2) Type 2- partially visible, and 3) Type 3- difficult to visualize. The preoperative HRCT measurements were used to predict the type of visualization of round window niche before surgery and correlated with the findings during surgery.Results:The mean and standard deviation for the distance between the short process of incus and the round window niche and for the distance between the oval window and the round window niche for Types 1, 2, and 3 were 8.5 ± 0.2 mm and 3.2 ± 0.2 mm, 8.0 ± 0.4 mm and 3.8 ± 0.2 mm, 7.5 ± 0.2 mm and 4.4 ± 0.2 mm respectively, and showed statistically significant difference (P < 0.01) between them. The preoperative HRCT measurements had a sensitivity and specificity of 92.3% and 96.2%, respectively, in determining the actual visualization of round window niche.Conclusion:This study shows preoperative HRCT temporal bone measurements are useful in predicting the actual visualization of round window niche as viewed through posterior tympanotomy.

Pars Tensa Retractions Without Cholesteatoma in Children

Determine predictive values of preoperative stages of pars tensa retractions, coexisting attic retraction and preoperative air conduction for ossicular destruction in isolated and combined pars tensa retraction, and predictors for successful tympanic grafts after surgery. Prospective case series study. Tertiary referral center. Forty-eight children ears without cholesteatoma were included in the study: 23 with isolated pars tensa retraction (median age, 11), 25 with combined pars tensa and attic retractions (median age, 13). Otomicroscopy, pure tone audiometry, and impedancmetry were carried out preoperatively. Three surgical procedures for isolated retractions were used: ventilation tube insertion alone or together with fascia graft or cartilage graft. Two surgical procedures for combined retractions were used: ventilation tube insertion alone and with cartilage graft. Incidence of ossicular destruction, postoperative retraction of the grafts. Stage of pars tensa retraction and preoperative air conduction thresholds do not predict long incus process defect in isolated group. Coexistence of an attic retraction predicts combined, long incus process and stapes superstructure defect (Chi = 3.943, p = 0.047, OR = 12.00). Retractions of grafts are predicted by mode of surgery, favoring cartilage graft (isolated group: Chi = 4.306, p = 0.0372,OR = 4.69; combined group Chi = 4.7836, p = 0.0287, OR = 0.1364). Stage of pars tensa retraction predicts poor outcome of fascia graft (Chi = 4.5347, p = 0.0332, OR = 12.00). Absence of correlation between stage of pars tensa retraction and air conduction thresholds with ossicular defects justifies surgical exploration of the auditory ossicles, even in lower stages of retraction. Combined ossicular defect is expected in combined retractions. The usage of cartilage graft proved to be more appropriate.

Cortical bone total ossicular replacement prosthesis

Objectives: Evaluate an autologous cortical bone total ossicular replacement prosthesis (B TORP) made of cortical bone for cost effective and sustainable hearing results. Materials and Methods: A prospective study was undertaken in the patients who underwent tympanoplasty with new B-TORP from January 2011 to December 2011. All patients had an absent superstructure of the stapes and long process of the incus due to chronic otitis media. Totally 40 patients were evaluated. Hearing results were evaluated using four-frequency average pure tone air conduction and air-bone gap (ABG) measured at 0.5, 1, 2, and 3 kHz after a period of 12 months. Pre- and post-operative continuous variables were compared using a paired t-test and data from unequal groups were assessed for significant differences using unpaired t-test. Results: Successful rehabilitation of the ABG to 20 dB or less was achieved in 95% of patients. Overall mean improvement in ABG was 25.8 ± 5.6 dB, which was statistically significant (t = 26.8, P 0.5). Conclusion: The new autologous B-TORP provides sustainable hearing improvement and is bio-compatible, stable, and magnetic resonance imaging compatible.

Anatomic Parameters of the Long Process of Incus for Stapes Surgery

The purpose of this study is to offer new anatomic data about the long process of incus (LPI) for stapes surgery. Anatomic study of 50 human macerated incudes to measure different parameters of cross sections of the LPI. Step-by-step cutting of the LPI perpendicular to its axis starting from its free end next to the lenticular process. The layer thickness was 0.5 mm. The cutting surfaces were documented with Canon EOS 20D camera, and a standard software tool (MATLAB) was used for automated statistical analysis. The LPI had a maximum diameter of 1.15 mm and a minimum diameter of 0.52 mm at the level of 1.5 mm far from the tip of the long process, which is the most common site for stapes prosthesis attachment. Concerning each cross section, having a long and a short diameter, the average long diameter is 0.9011 mm, and the short diameter is 0.6507 mm. Our anatomic study revealed wide variations of diameters and shape of the LPI. Best possible crimping of stapes prosthesis depends not only on the shape and diameters of the LPI but also on the vertical surface of the LPI as well. To prevent incus necrosis due to compression of the feeding blood vessels, the maximum contact surface of the loop of stapes prosthesis should be about 1.9 mm in length.

Alternative Fixation of an Active Middle Ear Implant at the Short Incus Process

Introduction: Since 1996, the preferred approach for positioning the active middle-ear implant Vibrant Soundbridge© is a mastoidectomy and a posterior tympanotomy. With this device, placement of the floating mass transducer (FMT) on the long incus process is the standard method for treatment of mild-to-severe sensorineural hearing loss in the case of normal middle-ear anatomy. The aim of this study was to determine the vibrational effectiveness of FMT placement at the short incus process. Materials and Methods: An extended antrotomy and a posterior tympanotomy were performed in 5 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane were (sequentially) measured by laser Doppler vibrometry. Vibration responses for coupling of an FMT to the long incus process (standard coupling) were compared to those for coupling to the short incus process. Results: Apart from narrow frequency bands near 3 and 9 kHz for the stapes footplate and RW membrane, respectively, the velocity responses presented no significant differences between standard coupling of the FMT and coupling to the short incus process. Conclusion: Coupling the FMT to the short incus process may be a viable alternative in cases where the surgical approach is limited to an extended antrotomy. A reliable technique for attachment to the short incus process has yet to be developed.

English

OBJECTIVE: To assess ossicular defects in patients with tubo-type of CSOM in relation to size of tympanic membrane perforation and its associated hearing loss. SETTING: This study was carried out in department of Oto-rhino-laryngology, Vinayaka Mission Medical College, Karaikal. (Tertiary Care hospital). METHODS: The study included 150 patients who attended ENT OPD from May 2012 to May 2013. The patients underwent ossiculoplasty and were diagnosed to have tubo- tympanic type of CSOM. The parameters studied were size of perforation of tympanic membrane, pre-operative hearing levels and intra-operative ossicular defects. RESULTS: Incus was the commonest ossicle affected especially the long process of incus. In some cases the entire incus was absent. Involvement of the incus was seen was highly evident in patients with subtotal perforation of the tympanic membrane. Majority of patients had conductive hearing loss between 39.40 to 59.60 dB in patients having either single or multiple ossicular involvements. CONCLUSIONS: Ossicular defects and associated hearing loss may occur in tubo-tympanic type of CSOM. Ossicular defects were more common in sub-total perforation of tympanic membrane than central perforation. Knowledge gained from this study could be utilized by ENT surgeons in efficient management of

The frequency response of a floating piezoelectric microphone for the implantable middle ear microphone

A piezoelectric sensor, floating piezoelectric microphone, driven by acoustic vibration of the ossicles, is one possible design for a microphone for a totally implantable cochlear implant. The purpose of the article was to study the frequency response of the floating piezoelectric microphone and to identify the ideal feasible position in the ossicular chain. Basic Research. The frequency response of the floating piezoelectric microphone was analyzed by finite-element modeling and in vitro testing of fresh cadaveric heads. The floating piezoelectric microphone, 5.0 mm in length and 1.5 mm by 1.2 mm in rectangular cross section, as a piezoelectric microphone, was placed at various locations on the ossicular chain and stimulated by pure tones of different frequencies. The floating piezoelectric microphone can pick up the vibration of the ossicular chain and effectively convert it into the electronic signals effectively both in the long process of incus and in the malleus. The average sensitivity of the FPM is -44.22 dB rms ref 1V at 1000 Hz in the long process of incus, -53.33 dB rms ref 1V at 1000 Hz in the malleus, and -108.59 dB rms ref 1V at 1000 Hz in the tympanic cavity. The floating piezoelectric microphone is expected to be used as an implantable middle ear microphone for the totally implantable cochlear implant.

The Non-Invasive Measurement of Geometry of Human Ossicles

This study is to reconstruct the 3D model of ossicles by the smoothing technique that fitted to the human ossicles. The length of the geometry of the model was then measured. The image of human ossicles was obtained by the micro computed tomography scan. The 3D model of human ossicles was reconstructed by image processing, and then the length of the geometry of the 3D model was measured. The 3D model of human ossicles was reconstructed by image processing and by surface smoothing technique in this study. The surface of the ossicles model was smoothed by Smoothsurface. The length of the short process of the incus was 1.8 mm. The length of the long process of the incus was 5.2 mm. Based on the results obtained by this study, there was almost no difference for the measurements of the lengths of the cadaver malleus and incus between by observation and by image processing. Therefore, the image processing method was convenient and reliable. By the 3D model of ossicles, the clinician could know the structure of middle ear and could diagnose the middle ear disease more exactly.

Ossiculoplasty for Monocrural Stapes Anomaly

Congenital anomalies of ossicle in the middle ear are rare and could appear in various forms. The most common congenital isolated ossicular anomalies are stapes fixation and incudostape dial discontinuity, with isolated congenital stapes fixation representing about one third of ossic ular malformations. We present a rare case of monocrural anomaly of unilateral stapes in a 36-year-old woman with nonprogressive conductive hearing loss. During explotympanotomy, the lateral half of the suprastructure of anomalous stapes was removed and sculptured total ossicular replacement prosthesis was fitted between the long process of incus and remained sta pes. Postoperative pure tone audiogram showed a significant decrease in air-bone gap. We report this case with a review of literature. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:448-51 Key WordsZZConductive hearing loss ㆍCongenital abnormalities ㆍStapes ㆍSurgical procedures.

Can fetal ossicles be used as prosthesis in adults? A morphometric study

Objectives:The tympanic cavity contains 3 small immovable bones, the malleus, incus and stapes. Extensive studies havebeen carried out on the morphometry of the ossicles. According to some scientists, in human beings the auditory ossiclesreach there definitive size and shape in fetal periods and postnatal modifications are minimal, while there are certain studies which their contradict this claim. These contradictory claims prompted us to make an endeavor to find out the growthpattern of the ear ossicles and comparing the data with adults. Methods: Twenty-two fetal cadavers of either sex, ranging in gestational ages between 24-40 weeks, were collected fromlocal hospitals and 15 adult formalin-fixed cadavers in age groups of 20-30 years were taken. For the study, the fetuses werekept in 2 Groups of 24-28 weeks and 36-40 weeks. From the data obtained, the mean, standard deviation and percentagegain from one group to another in different dimensions of various parts of each ossicle was calculated. Results: The age periods between 40 weeks (full term fetuses) and adults, revealed spurt in the growth of diameter of headof malleus (3%), width of short process of incus (2.7%), width of footplate (5.2%) and height of stapes (13%). Thesechanges were insignificant in terms of acoustic transmission. Conclusion:It is concluded that by the end of gestation, the ear ossicles develop morphometric features comparable to adultswith no appreciable changes in the post natal period. Hence, they can be used as prosthesis in adults suffering from ossicularchain malformations and can be an easy and cheap method for treatment of this type of patients

Labyrinthine fenestration for tympanosclerotic stapes fixation

To report the results obtained in patients with intact tympanic membrane tympanosclerotic stapes fixation treated by labyrinthine fenestration and to discuss the value of this operation. Retrospective study of 28 cases of tympanosclerotic stapes fixation operated between 1982 and 2010. Labyrinthine fenestration was performed using a CO(2) laser. In the first group of patients, the columellar effect was restored by stapedectomy with graft interposition and reconstruction was performed by TORP prosthesis and in the second group, stapedotomy was performed with reconstruction by a piston crimped onto the long process of incus (LPI) or the malleus handle (MH). Postoperatively (2 to 6 months), stapedectomy and reconstruction by TORP prosthesis allowed a gain of the mean Rinne by 18 dB and reconstruction by piston crimped onto the LPI or an MH placed in the stapedotomy orifice allowed a gain of 14 dB. With a follow-up of 3 years, this gain was maintained with the first technique. No case of cophosis or sensorineural hearing loss greater than 20 dB was observed. Labyrinthine fenestration provides an immediate hearing gain in patients with tympanosclerotic stapes fixation with the two techniques used. In the longer term, these good results were maintained with the stapedectomy and TORP prosthesis technique, but the hearing gain was no longer statistically significant in the long-term with the stapedotomy technique because of a limited number of cases. However, only a study based on a larger number of patients would be able to confirm the superiority of TORP compared to stapedotomy. Labyrinthine fenestration, which comprised only a low risk of deterioration of hearing and which did not induce any total hearing loss, must nevertheless be performed only in the case of severe bilateral conductive hearing loss, with an intact tympanic membrane, in patients refusing a hearing aid and informed about the risks of deterioration of hearing.