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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(03): e374-e378
DOI: 10.1055/s-0040-1715152
Original Research

Alternative Inverted Middle Fossa Approach in Bonebridge Surgery. Technique, Results and Complications

Mario E. Zernotti 
1   Department of ENT, Universidad Nacional de Cordoba, Sanatorio Allende, Cordoba, Córdoba, Argentina
2   Department of Otorhinolaringology, Universidad Nacional de Cordoba, Cordoba, Córdoba, Argentina
3   Department of Otorhinolaringology, Universidad Católica de Cordoba, Cordoba, Córdoba, Argentina
,
Maria F. Di Gregorio 
1   Department of ENT, Universidad Nacional de Cordoba, Sanatorio Allende, Cordoba, Córdoba, Argentina
,
Máximo Zernotti 
1   Department of ENT, Universidad Nacional de Cordoba, Sanatorio Allende, Cordoba, Córdoba, Argentina
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Abstract

Introduction The transmastoid approach is the most recommended technique to Bonebridge surgery, while in patients with bad anatomy or in the canal wall down technique, retrosigmoid or Middle Fossa Approaches are the alternative surgical options.

Objective To describe a novel alternative approach called inverted middle fossa approach (IMFA) and its technique and audiological outcomes.

Methods Seven patients submitted to the IMFA were included. All patients presented conductive and mixed hearing loss with bone thresholds of the audiogram > 40 dB. The audiological test was conducted pre- and postoperatively.

Results A total of 5 males and 2 females, aged 13,8 years old (range 6–25 years old) were studied. The average follow-up was of 20 months (12 to 32 months). All patients presented aural atresia, except one with severe osseous-fibrous dysplasia of the temporal bone. Two patients showed bilateral compromise, three patients had associated Goldenhar and Treacher Collins syndrome. On the preoperative audiograms, air conduction (AC) thresholds showed a PTA4 (0.5, 1, 2 and 4 kHz) of 66.7 dB (standard deviation [SD] =  ± 7.8), while the bone conduction thresholds reached an average of 11.2 dB (SD =  ± 6.9). The postoperative thresholds did not change, and additional sensorineural damage was not observed before activation. Four weeks after surgery, all the patients were fitted with the external processor. The postoperative audiological aided exam showed AC PTA 4 thresholds of 18.9 dB (SD =  ± 5.9).

Conclusion The IMFA allows the nearest position of the microphone to the external auditory canal. The technique is a suitable option to the 3 classical approaches with similar rate of audiological results. More investigation is needed to determine the benefit of the novel approach compared with the others.

Keywords

conductive hearing loss - aural atresia - bone conductive hearing implant


Publication History

Received: 03 May 2020

Accepted: 24 June 2020

Article published online:
24 September 2020

© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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