Adjunctive tenotomy during middle ear surgery

INTRODUCTION We describe indications and surgical technique for dividing the stapedius and tensor tympani tendons during middle ear surgery. Middle ear muscle reflexes involve contraction of the tensor tympani muscle (TTM) and stapedius muscle (SM) to increase impedance of the middle ear, and may shield the inner ear from loud, continuous nonimpact noise. Sectioning SM and TTM tendons has been advocated for a number of conditions, including improving access to anterior epitympanic (supratubal) recess, releasing a medialized malleus during tympanoplasty and ossiculoplasty, tensor or stapedial myoclonus, reflexive vertigo, and Meniere disease.