Marked enhancement of bone conduction subsequent to TORP implantation following oval window reinforcement: A case report and comprehensive narrative review

To report a rare case of a marked improvement in bone conduction (BC) thresholds following the reinforcement of the oval window (OW) prior to the implantation of a total ossicular replacement prosthesis (TORP). A clinical case involving OW reinforcement followed by TORP implantation was retrospectively analyzed, with pre- and postoperative pure tone averages (PTA) at four frequencies for BC and air conduction (AC) measured and compared. The bone conduction pure tone average (PTA) across four frequencies improved significantly from 62 dB preoperatively to 16 dB postoperatively in the patient's only hearing ear, which had previously experienced acute hearing loss and was affected by cholesteatoma. Concurrently, the air conduction (AC) PTA also improved, decreasing from 76 dB to 33 dB. In patients presenting with benign middle ear lesions that result in destruction of the stapes footplate and concomitant reduction in BC, it is essential to first exclude sensorineural etiologies, including labyrinthitis and auditory neuropathy. Subsequently, consideration should be given to reinforcing the OW utilizing autologous cartilage. • Marked BC improvement was achieved after OW reinforcement prior TORP implantation in a only hearing ear with cholesteatoma. • The alteration in bone conduction (BC) outcomes following lesions in the patient's inner ear ossicular labyrinth and her subsequent surgical restoration corroborates the validity of prior theoretical models concerning the human BC mechanism. • The findings of this investigation provide a novel mechanistic explanation for the abrupt reduction in BC sensitivity associated with middle ear cholesteatoma.