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When tympanoplasty is performed for conductive hearing loss due to otitis media, hearing recovery may not be as good 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, particularly of the ossicular ligaments, specimens of human temporal bones were studied. Histology of the anterior malleal ligament, posterior incudal ligament, and stapediovestibular ligament was examined in 636 ears 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 compared between normal and chronically inflamed ears. In anterior malleal and posterior incudal ligaments, the severity of sclerotic hyalinization and calcification increased with age in normal ears, but sclerotic changes in chronically inflamed ears were more severe than in normal ears and displayed a reduced association with age. Conversely, sclerosis of the stapediovestibular ligament was less severe than that of the anterior malleal and posterior incudal ligaments in both normal and chronically inflamed ears, and displayed a reduced relationship with age. The sclerotic changes apparent in the anterior malleal and posterior incudal ligaments therefore seem to be more readily influenced by inflammation than by age. Sclerotic changes of the stapediovestibular ligament are not as severe as those of anterior malleal and posterior incudal ligaments. For cases in which tympanoplasty of inflamed ears is planned, mobility of the anterior malleal and posterior incudal ligaments should be tested independent of testing of the stapediovestibular ligament. When mobility of anterior malleal and posterior incudal ligaments is not as good as mobility of the stapediovestibular ligament, surgical modification of the anterior malleal and posterior incudal ligaments may be advisable.

Sclerotic Changes in Ossicular ligaments in Human Temporal Bone Pathology