Sclerotic Changes in Ossicular Ligaments in Human Temporal Bone Pathology

When tympanoplasty is performed for conductive hearing loss due to otitis media, hearing recovery may not be asgood as anticipated preoperatively. Sclerotic changes may therefore exist in the conduction system of the middle ear.To clarify the relationship between middle ear inflammation and sclerotic changes of middle ear sound conduction, par-ticularly of the ossicular ligaments, specimens of human temporal bones were studied. Histology of the anterior mallealligament, posterior incudal ligament, and stapediovestibular ligament was examined in 636 cars from 367 individuals(postmortem) ranging from infancy to 90 years old and without blood disease, neoplasm, anomaly, or cholesteatoma.Only small numbers of acute and subacute inflammatory were identified, but sclerotic changes in ligaments were com-pared between normal and chronically inflamed ears. In anterior malleal and posterior incudal ligaments, the severity ofsclerotic hyalinization and calcification increased with age in normal cars, but sclerotic changes in chronically inflamedears were more severe than in normal ears and displayed a reduced association with age. Conversely, sclerosis of thestapediovestibular ligament was less severe than that of the anterior malleal and posterior incudal ligaments in both nor-mal and chronically inflamed ears, and displayed a reduced relationship with age. The sclerotic changes apparent in theanterior malleal and posterior incudal ligaments therefore seem to be more readily influenced by inflaummation than byage. Sclerotic changes of the stapediovestibular ligament are not as severe as those of anterior malleal and posterior in-cudal ligaments. For cases in which tympanoplasty of inflamed ears is planned, mobility of the anterior malleal and pos-terior incudal ligaments should be tested independent of testing of the stapediovestibular ligament. When mobility of an-terior malleal and posterior incudal ligaments is not as good as mobility of the stapediovestibular ligament, surgical modi-fication of the anterior malleal and posterior incudal ligaments may be advisable.