Copyright © 2017 Address correspondenc M.D., USC Caruso Depa Surgery, 1540 Alcazar, S john.oghalai@med.usc.ed Y.V. and D.K.H. contr The authors disclose n DOI: 10.1097/MAO.0 athological temporal bone remodthe temporal bones without con Otosclerosis is a p eling that affects the otic capsule. The prevalence of this condition is 0.3% among Caucasians, with a male:female ratio of 1:2 (1). Otosclerosis affects the stapes footplate, causing conductive hearing loss. More severe cases involve the cochlear endosteum, which can add a sensorineural component to the hearing loss. Treatment via surgical intervention consists of stapedotomy, with an approximate success rate of 90% (2). Displacement of the prostheses, whether due to incus erosion and/or expulsion of the piston from the vestibule, is typically responsible for most of the failures. However, undetected concurrent malleus fixation may account for 0.8 to 4.0% of these failures, with anterior malleus ligament fixation being the most common source (3,4). A 38-year-old male presented to our clinic with bilateral conductive hearing loss. It was worse on the left side and had gradually deteriorated over the past 2 years. Past medical history was significant for chronic sinusitis and childhood otitis media with ventilation tube insertion at the age of 6. There was no relevant family history of otosclerosis. On physical examination, under the microscope, a normal tympanic membrane with no myringosclerosis was observed. Tuning fork test: Weber lateralized to the left and Rhinne demonstrated that bone conduction was greater than air conduction bilaterally. Acoustic reflexes were absent bilaterally. Audiometry revealed bilateral moderate conductive hearing loss with Carhart notches. The speech reception threshold (SRT) was 30 dB with air-bone gap of 15 dB on the right side and the SRT was 45 dB with an air-bone gap of 27 dB on the left side. The word recognition score was 100% bilaterally. High-resolution computed tomography of
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