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Case Report/Case Series |

Congenital Incus Fixation to the Fallopian Canal

Christopher R. Selinsky, DO1; Jeffery K. Kuhn, MD2
[+] Author Affiliations
1Department of Otolaryngology, Doctor’s Hospital, Columbus, Ohio
2Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Otolaryngol Head Neck Surg. 2014;140(8):762-764. doi:10.1001/jamaoto.2014.1026.
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Importance  An isolated congenital anomaly of the ossicular chain is a rare finding in an ear that, otherwise, appears clinically normal. The most common congenital ossicular anomaly is fixation of the stapes footplate. The least common congenital ossicular anomaly is isolated incus fixation, with only a few reported in the literature.

Observations  We describe a woman in her 50s with a long history of left-sided hearing loss and unremarkable neurotologic findings aside from a tuning-fork examination result suggestive of left-sided conductive hearing loss. Intraoperatively, she was found to have isolated fixation of the incus to the fallopian canal. The incus–fallopian canal fixation was separated, and an autologous bone graft was placed between the lenticular process and stapes capitulum to create elevation and prevent refixation. One month postoperatively, an audiogram revealed a nearly complete air-bone gap closure.

Conclusions and Relevance  Patients who present with conductive hearing loss, normal physical examination findings, and an apparent normal radiograph are generally assumed to have otosclerosis. This case illustrates an unanticipated unique anomaly that was surgically corrected by releasing the bony fixation of the incus to the fallopian canal and placing an autologous bone graft at the incostapedial joint.

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Figure 1.
Audiograms From the Reported Case

A, The preoperative audiogram demonstrates left moderate mixed hearing loss. B, The 1-month postoperative audiogram demonstrates closure of the preoperative air-bone gap.

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Figure 2.
Axial High-Resolution Computed Tomographic Image of the Temporal Bone

The temporal bone demonstrates bony fixation between the left incus and fallopian canal.

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Figure 3.
Intraoperative Images From the Reported Case

A, The long process of the incus fixated to the fallopian canal. B, The autologous interposition bone graft between the lenticular process of incus and the stapes capitulum.

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