Efficacy of endoscopic removal of anterior malleolar ligament calcification combined with tympanic membrane repair for the treatment of conductive hearing loss

Abstract

Objective: Anterior malleus ligament calcification (AMLC) can restrict malleolar mobility, thereby impairing sound conduction through the ossicular chain and potentially contributing to conductive hearing loss (CHL). The study aimed to investigate the pathogenic role of calcification of the anterior malleus ligament in CHL and to evaluate the efficacy of endoscopic removal of AMLC with concurrent tympanic membrane repair.

Methodology: Clinical data of 68 CHL patients (68 ears) who underwent endoscopic tympanoplasty in Tongren Hospital, Shanghai Jiao Tong University School of Medicine (January, 2019 – December, 2023) were retrospectively analyzed. All patients had intraoperatively confirmed AMLC and no other obvious ossicular chain lesions. Endoscopic removal of AMLC and concurrent tympanic membrane repair were performed. Pure-tone audiometry indices (air conduction threshold [ACT], bone conduction threshold [BCT], air-bone gap [ABG]) and tympanic membrane healing were compared preoperatively and at one, three and six months postoperatively to assess surgical efficacy and complications.

Results: All patients were followed up for 6~12 months, with 100% primary tympanic membrane healing. Postoperative ACT and ABG were significantly improved compared to preoperative values (P<0.05). At 6 months postoperatively, mean ACT decreased from 56.32±8.75 to 25.16±5.38 dB HL, and mean ABG narrowed from 31.25±6.42 to 8.67±3.15 dB HL (both P<0.01). No severe complications occurred.

Conclusions: Calcification of AML is an important cause of CHL. Endoscopic AMLC removal combined with tympanic membrane repair was associated with favorable short-term hearing improvement, with the advantages of minimal invasiveness, clear visualization, and few complications. Furthermore, for patients with CHL and intact ossicular chains, the possibility of AMLC should be vigilantly considered. However, the findings mainly reflect short-term outcomes, and the diagnosis relied heavily on intraoperative identification. Therefore, the findings should be interpreted with caution.