title: Can an incomplete ossicular discontinuity be predicted by audiometric and clinical findings?
abstract: OBJECTIVE
  To investigate a pathology of conductive hearing loss caused by an incomplete ossicular discontinuity. It can manifest as a triad of the following: 1) conductive hearing loss most prominent in the high frequencies (hfCHL), defined as [ABG for 4 kHz] > [mean ABG for 0.25-0.5 kHz] + 10 dB or more; 2) fluctuating hearing loss; and 3) short-lasting improvement of hearing after Valsalva maneuver.
  
  
  METHODS
  Retrospective clinical trial.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Fourteen patients with an incomplete ossicular discontinuity who underwent incus interposition were included.
  
  
  METHODS
  Incus interposition, mathematical model.
  
  
  METHODS
  First, the prevalence of the triad was documented. Second, the hypothesis that mechanical ossicular compliance was responsible for the triad of symptoms was evaluated and simulated in a mathematical model. Finally, the postoperative hearing results with a follow-up of 12 months were analyzed and compared with those reported in the literature.
  
  
  RESULTS
  The presence of the triad of symptoms is a strong indicator for detecting patients with an incomplete ossicular discontinuity. High frequency conductive hearing loss was present in 93% (13/14 patients). Ten (71%) of the 14 patients presented with fluctuating hearing loss and improvement of hearing after Valsalva maneuver. The hfCHL could be simulated adequately in the mathematical model. Success rate for surgical intervention (ABG < 20 dB; 0.5, 1, 2, and 3 kHz) was 93% and was comparable to the results reported in the literature.
  
  
  CONCLUSIONS
  Patients with hfCHL, fluctuating hearing loss, and improvement of hearing after Valsalva maneuver are likely to have an incomplete ossicular discontinuity. A favorable postoperative hearing recovery by incus interposition can be expected.
authors: Clinic of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Jae Hoon
authors: JH
authors: Sim
authors: Alexander M
authors: AM
authors: Huber
authors: Marc
authors: M
authors: Häfliger
authors: Lorraine A
authors: LA
authors: de Trey
authors: Albrecht
authors: A
authors: Eiber
authors: Christof
authors: C
authors: Röösli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction / Q000502:physiology*; D004429:Ear Ossicles / Q000601:surgery*; D005260:Female; D006314:Hearing Loss, Conductive / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement; D012189:Retrospective Studies; D016896:Treatment Outcome