• Anita Jeyakumar, Todd M Brickman, Kim Murray, and Paul Dutcher.
• Department of Otolaryngology, University of Rochester, Rochester, New York 14642, USA. anita_jeyakumar@urmc.rochester.edu
• Otol. Neurotol. 2006 Jun 1;27(4):466-8.

ObjectiveTo describe a unilateral progressive conductive hearing loss caused by incus discontinuity (without erosion of the long process of the incus), and otosclerosis with fixation of the stapedial footplate.Study DesignCase report.SettingDepartment of Otolaryngology, Head and Neck Surgery of the University of Rochester Medical Center, which is a regional tertiary referral center.PatientA 54-year-old woman with multiple otologic complaints including tympanic membrane perforations, otalgia, tinnitus, and hearing loss. Audiography demonstrated 100% speech discrimination bilaterally and a significant conductive right-sided hearing loss.InterventionThe patient underwent a stapedectomy, during which a discontinuity between the long process of the incus and the stapes with no bony erosion was identified. The stapedectomy was completed and an ossicular piston prosthesis was inserted to reestablish ossicular continuity with the tympanic membrane.Main Outcome MeasureImproved subjective hearing confirmed objectively by audiography.ConclusionThis is the third reported case of an unusual combination of otosclerosis and ossicular discontinuity, and the first such case report in a patient without head trauma. In addition, it adds a unique item to the differential diagnosis of the pathologic features implicated in an ear with a conductive deficit and normal tympanogram.

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