Malleostapedotomy: Recent Innovations and Surgical Outcomes

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Purpose of Review

Malleostapedotomy (MS) is a challenging otologic surgical technique involving complex anatomic relationships and nuanced technical considerations. Over the past few decades, MS has been refined by development of customized prostheses and enhanced understanding of relevant ossicular anatomic dimensions. This article presents outcomes with a self-crimping angulated malleostapedotomy piston and reviews recent published advancements relevant to MS surgery.

Recent Findings

Excellent results are reported with a self-crimping angulated nitinol piston including AB gap closure < 20 dB in the majority of cases and < 10 dB in many cases. Innovations in surgical technique include consideration for shifting the crimp site to the malleus neck, possible repositioning of the malleus, and use of an endoscope. Prosthesis sizing may be optimized by specialized instruments or preoperative 3D radiologic imaging.


Malleostapedotomy remains a viable option for management of stapes fixation when traditional incus-grip techniques are not possible. Ongoing innovation in technique and prosthesis may further advance hearing outcomes in to the future.

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    Papers of particular interest, published recently, have been highlighted as: • Of importance

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    Author information

    Correspondence to Michael B. Gluth.

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    Conflict of Interest

    Lucy J. Xu declares that she has no conflict of interest.

    Michael B. Gluth reports personal fees from Osler Otolaryngology Review. He also designed the prosthesis involved with the case series presented; however, he does not and never has received any royalties or other compensation whatsoever from the manufacturer (Grace Medical) for this work.

    Human and Animal Rights and Informed Consent

    IRB approval was obtained at the University of Chicago: #18-1713.

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    This article is part of the Topical Collection on Ossicular Chain Reconstruction

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    Xu, L.J., Gluth, M.B. Malleostapedotomy: Recent Innovations and Surgical Outcomes. Curr Otorhinolaryngol Rep (2020).

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    • Malleostapedotomy
    • Malleovestibulopexy
    • Malleus-grip stapedotomy
    • Otosclerosis
    • Tympanosclerosis
    • Conductive hearing loss