case_images: PMC6679842_01
case_images: Preoperative pure tone audiometry revealed bilateral moderate rising to mild conductive hearing loss on the right (a) and left (b). Ipsilateral and contralateral stapedial reflexes were absent bilaterally.
case_images: CRIG2019-2836263.001.jpg
case_images: PMC6679842_01_CRIG2019-2836263.001.jpg
case_images: fig1
case_images: Pure tone audiometry revealed bilateral moderate rising to mild conductive hearing loss bilaterally (Figure 1).
case_images: Axial CT bone windows of the temporal bones revealed a markedly enlarged incus with possible fixation in both the right (a) and the left ears (a). Coronal reformats on the left (c) demonstrated an elongated stapes superstructure of approximately 4.8 mm (dashed line) with thickening of the incus long process (arrowhead). On the right (d), this measurement was 4.5 mm. Coronal views of the right ear demonstrated bony dehiscence or thinning in the tegmen mastoideum without meningoencephalic herniation. Similar findings were noted on the left.
case_images: CRIG2019-2836263.002.jpg
case_images: PMC6679842_01_CRIG2019-2836263.002.jpg
case_images: fig2
case_images: CT imaging of the temporal bones revealed an enlarged incus with possible fixation in both the right (Figure 2(a)) and the left (Figure 2(b)) ears. Coronal reformats demonstrated an elongated stapes superstructure of approximately 4.5 mm on the right and 4.8 mm on the left with thickening of the incus long process bilaterally (Figure 2(c)). Tegmen dehiscence or thinning was noted bilaterally in the tegmen mastoideum without meningoencephalic herniation (Figure 2(d)).
case_images: Postoperative pure tone audiometry revealed improvement of the air conduction thresholds to a mild conductive hearing loss with near closure of the air-bone gap on the right. Unfortunately, the patient has not followed up for postoperative audiogram after his second operation but reports subjectively improved and symmetric hearing.
case_images: CRIG2019-2836263.003.jpg
case_images: PMC6679842_01_CRIG2019-2836263.003.jpg
case_images: fig3
case_images: The patient's postoperative pure tone and speech recognition thresholds improved significantly after surgery (Figure 3).