# Intact Transmastoid Ossicle Swaying Technique to Preserve Hearing in Pediatric Facial Nerve Decompression Surgery: A Case Report

## TL;DR

A new surgical technique preserves hearing in a child undergoing facial nerve decompression surgery, showing improved outcomes compared to conventional methods.

## Contribution

The intact transmastoid ossicle swaying technique is introduced as a less invasive method for pediatric facial nerve decompression.

## Key findings

- The patient showed improved auditory and facial nerve function post-surgery.
- Hearing thresholds remained stable, and facial nerve function improved from Grade V to Grade II.
- The ITO technique reduces the risk of hearing loss compared to conventional approaches.

## Abstract

When pharmacological treatments are inadequate, facial nerve paralysis from various etiologies, including Bell’s palsy, Hunt syndrome, and trauma, often requires surgical intervention. Facial nerve decompression surgery aims to relieve nerve compression and restore function, with preserving hearing function, especially in pediatric cases, being crucial. Conventional methods, like the transmastoid approach, risk affecting auditory function due to ossicle manipulation. Herein, we describe the case of a 12-year-old boy with left facial palsy diagnosed with zoster sine herpete (ZSH) syndrome. Despite medical treatment, the patient’s condition did not improve, prompting facial nerve decompression surgery. Employing the intact transmastoid ossicle (ITO) swaying technique, we minimized ossicular manipulation, preserving auditory function while effectively achieving facial nerve decompression. The patient demonstrated improvement postoperatively in auditory and facial nerve functions. Furthermore, audiometric assessments demonstrated no substantial deterioration in hearing thresholds, and the facial nerve function improved from Grade V to Grade II on the House-Brackmann scale. The ITO technique provides a less invasive alternative compared to conventional approaches, lowering the chance of the ossicular chain and the risk of postoperative hearing loss. This case highlights the significance of customized surgical approaches in pediatric facial nerve decompression surgery, resulting in improved patient outcomes. Further research is required to validate the efficacy and safety of this method across various clinical contexts.