# Malleostapedotomy in Patients With Stapes Fixation: A Systematic Review

## TL;DR

This systematic review evaluates malleostapedotomy as a surgical option for patients with stapes fixation, finding it to be a safe and effective alternative to other procedures.

## Contribution

The study systematically reviews the indications, techniques, and outcomes of malleostapedotomy for stapes fixation, highlighting its role in revision surgeries.

## Key findings

- Malleostapedotomy is commonly used in revision otosclerosis surgery when incus anchoring stapedoplasty is not feasible.
- Approximately 84.9% of cases achieved an air-bone gap closure within 20 dB, indicating favorable hearing outcomes.

## Abstract

To review the literature regarding malleostapedotomy as primary or revision surgery in patients with stapes fixation, to point out the state of the art regarding indications, techniques and outcomes of this procedure.

PubMed, CINAHL and Cochrane databases were screened following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.

Clinical studies describing malleostapedotomy in patients with stapes fixation were included in this Systematic Review. Data about indications, intraoperative findings, features of the prostheses and audiological results were recorded.

A total of 25 articles and 632 ears that underwent malleostapedotomy were included in the analysis. This technique has been employed for both primary and revision surgeries, evolving over time alongside advancements in the prostheses used. Revision otosclerosis surgery was identified as the most common surgery necessitating malleostapedotomy. Among the cases, 44.8% achieved ABG closure within 10 dB, while 84.9% achieved ABG closure within 20 dB.

Malleostapedotomy is a safe and valid surgical technique that can be performed when incus anchoring stapedoplasty is not feasible.

This systematic review analyses the current evidence on malleostapedotomy as a primary or revision procedure in patients with stapes fixation. Twenty‐five studies comprising 632 operated ears were included. Malleostapedotomy proved to be a safe and effective alternative to incus‐anchoring stapedoplasty, with favorable hearing outcomes and a low complication rate.