Diagnosis and Clinico-Radiologic Correlations in Conductive Hearing Loss with a Normal Appearing Tympanic Membrane

  • Salah Mansour
  • Jacques Magnan
  • Karen Nicolas
  • Hassan Haidar


In most instances of conductive hearing loss (CHL) with normal appearing tympanic membrane (NATM), the etiological diagnosis is easily suspected and confirmed with explorative tympanotomy. Nowadays a good counseling of the patients requires the use of modern available investigation methods to detect the correct causal diagnosis before undergoing any otologic intervention.

In this chapter a comprehensive methodology is proposed as a guideline to better deal with this clinical and sometimes conflictual situation, that relies primarily on a good history taking. Modern audiology tests are explained and interpreted thoroughly according to each possible pathology. Accurate imaging along with clinico-radiologic correlations contribute not only in the diagnostic issue and help in the selection of best management of the causal pathology but also reveal pertinent associated anatomical abnormalities.

Multiple scenarios will be fully discussed in this chapter: In cases of CHL with NATM and a positive familial history, otosclerosis is the most common cause, followed by a possible malleus fixation syndrome. In the context of CHL with NATM and past history of recurrent ear infections, ossicular chain discontinuity and tympanosclerosis are the most frequent pathologies. CHL with NATM and past history of head trauma raises suspicion of a posttraumatic ossicular chain disruption; CHL with NATM associated to vertigo and Tullio phenomenon is highly indicative of a third window phenomenon, etc…

In the pediatric population, the order of frequency of the underlying causes of CHL with NATM is quite different as they are mostly due to stapedovestibular ankyloses; juvenile otosclerosis being almost rare. Congenital ossicular chain anomalies, abnormal fixation of the chain to the attic wall or morphological anomalies of the stapes along with hypoplasia or atresia of the oval window are also to be considered.

In addition, the intriguing situation of CHL with NATM and a negative accurate CT-Imaging is discussed.

The aim of this chapter is to invite candidates and otologists to apply advanced modern performances in complimentary investigations every time they are in front of cases of a CHL with NATM in order to reduce surgical hazards or failure.

However, in negative accurate CT-Imaging, exploration tympanotomy remains the gold standard diagnostic measure.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Salah Mansour
    • 1
  • Jacques Magnan
    • 2
  • Karen Nicolas
    • 3
    • 4
  • Hassan Haidar
    • 5
  1. 1.Lebanese University, Department of OtolaryngologyHNS Amoudi Center Boulevard MazraaBeirutLebanon
  2. 2.Aix-Marseille UniversityMarseilleFrance
  3. 3.Department of RadiologyMiddle East Institute of HealthBsalimLebanon
  4. 4.Lebanese UniversityBeirutLebanon
  5. 5.Department of OtolaryngologyHamad Medical Corporation, Weill Cornell Medical CollegeDohaQatar

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