Ossicular Discontinuity

As the conduction of sound from the outer ear to the inner ear is dependent on the bones of hearing or ossicles, a disruption of the ossicles will result in conductive hearing loss.

The ossicles are comprised of the malleus, the incus, and the stapes. The malleus is the ossicle attached to the ear drum. The malleus is then connected to the incus, which is connected to the stapes. The stapes bone is in direct contact with the inner ear. In situations such as trauma or infection, any of the ossicles may be affected.

In cases of severe head trauma, the connection between the incus and stapes, which is fragile, can be separated. In other cases, the incus bone itself is fractured producing a separation between the incus and the stapes.

With recurrent ear infections or in conditions such as cholesteatoma, the tip of the incus at its point of connection with the stapes is eroded resulting in a separation between the incus and stapes. With infection, the stapes bone itself can be eroded leaving only the platform by which it is in connection with the inner ear.

The conductive hearing loss that results from the lack of continuity of the ossicles can be treated by one of 2 routes. The first one includes hearing aids. As amplification of sound can overcome the hearing loss that results of ossicular discontinuity, this option can produce significant benefit.

Surgery can also be performed to reconstruct the ossicular continuity. This procedure is ambulatory, meaning no overnight hospital stay is required. Admission and discharge from the hospital is on the same day as the operation. Depending on the circumstances that exist behind the ear drum, the ossicular chain can be recreated by sculpting the incus bone or by the insertion of a prosthesis, or a “manufactured” ossicle. Surgery is performed either through the ear canal or through an incision in the back of the ear.