Stapedius tendon ossification: Meaning of the ossicle of Paaw
DOI:
https://doi.org/10.34631/sporl.722Keywords:
Stapedius tendon, Hearing loss, conductive, ossicular chainAbstract
Introduction: Stapes tendon ossification is an uncommon ossicular congenital malformation with autosomal dominant inheritance. Globular supernumerary sesamoid bone within the stapes tendon was described by several anatomists. We have found a fixed stapes by a bony bridge between pyramidal eminence and stapes head keeping the habitually morphology and consistency of the stapedial tendon.
Material and method: 40 year old female patient presented with progressive bilateral hearing loss history with similar family history. We present clinical examination, complementary studies, treatment and course.
Discussion: Patients with a conductive or mixed hearing loss, normal or low compliance, and acoustic reflex with inverted pattern in 2000 Hz, CT images can be diagnostic in 25-67 % of the cases, facilitating treatment planning. A linear image attenuation of soft tissues in CT from the pyramidal eminence to the stapes is suggestive of a congenital ossification of the stapedial tendon. A small globular or rounded image inside the stapes tendon corresponds to the existence of Paaw bone. Elimination of the bony bridge preserving the integrity of the ossicular chain and its tendons restores the problem of hearing loss.
References
Grant W, Grant W. Stapedius tendon ossification: a rare case of
congenital conductive hearing loss. J Laryngol Otol.1991;105:763-764.
Hara A, Ase Y, Kusakari J, Kurosaki Y. Dominant hereditary conductive
hearing loss due to an ossified satpedius tendon. Arch Otolaryngol
Head Neck Surg.1997;123:1133-1135.
Graboyes E, Chole R, Hullar T. The ossicle of Paaw. Otol Neurotol.
;32:1185-1188.
Tabuchi K, Murashita H, Okubo H, Takahashi K, Wada T, Hara A.
Chain abnormality in patients with conductive deafness without
perforation of the tympanic membrane. Arch Otolaryngol Head Neck
Surg.2005;131:686-689.
Kösling S, Omenzetter M, Bartel-Friedrich S. Congenital malformations
of the external and middle ear. Eur J Radiol.2009;69:269-79.
Lemmerling M, Stambuk H, Mancuso A, Antonelli P, Kubilis P. CT of
the normal suspensory ligaments of the ossicles in the middle ear. Am
J Neuroradiol.1997;18:471-477.
Kurosaki Y, Kuramoto K, Itai Y, Hara A, Kusakari J. Congenital
ossification of the stapedius tendon: diagnosis with CT.
Radiology.1995;195:711-714.
Zixiang Y, Yang J, Li Z, Zhou A, Lin Y. Bilateral congenital absence
of stapes and oval window in 2 members of a family: etiology and
management. Otolaryngol Head and Neck Surgery.2003;128:777-782.
Jecker P, Hartwein J. Ossification of the stapedius tendon as a
rare cause of conductive hearing loss. Laryngo Rhino Otologie.
;105:763-764.
