of the Stapes and Facial Nerve

WITH THE advent of microsurgery, an increasing number of middle ear anomalies are being recognized. This case presents congenital deformities of both the stapes and horizontal portion of the facial nerve. This 15-year-old white boy was noted to have a hearing loss in infancy by his parents. He spoke his first words at 16 months. Speech has developed fairly well and intelligibility is fair to good. He began wearing a hearing aid at the age of 6. At present, he functions best with a binaural aid. Despite his speech and hearing handicap, he has been able to keep up with his class and maintain satisfactory grades. Initial examination showed normal structures of the auricle, external auditory meatus, and tympanic membrane. The nose, throat, and general physical examination showed no other abnormalities. Pure tone audiograms showed the bone conduction at 0 db and 60 db air conduction loss across-the\x=req-\ board. Differential diagnosis included: (1) congenital fixation of the footplate; (2) congenital ossicular deformity; and (3) oto¬ sclerosis. Surgical Findings