Exclusive Endoscopic Malleus Head Interposition

To begin, prepare all the necessary surgical tools and equipment for the procedure. Disarticulate the incus from the incudostapedial joint, and then remove the incus. Identify the malleus and dissect the chorda tympani from its neck.

Using the Malleus Nipper, transect the malleus neck and remove its head for its intended use in the interposition procedure. To grind the graft, hold the malleus head using a grasping forceps, and using a burr, carefully drill until the level of the malleus neck is reached. Drill an acetabulum on the malleus head approximately one millimeter wide to accommodate the head.

After carrying the graft towards the tympanic cavity, position the malleus head onto the stapes head and readjust its interposition using a microneedle. Stabilize the malleus head interposition with gelatin sponges, and close the tympanomeatal flap. The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 23.05 decibels, whereas after surgery, the average air-bone gap was reduced to 21.90 decibels.