There is no actual danger in the operation, but if the stapes is fixed or if much force is used, it is by no means difficult to fracture the crura of the stapes.
REMOVAL OF THE OSSICLES
Except under the most rare conditions only the malleus and incus are removed; the stapes, if possible, being left undisturbed.
These operations will therefore be considered separately.
Removal of the malleus and incus. This operation was first proposed by Schwartze in 1873, and later by Kessel, Ludewig, Sexton, and Zeroni.
Indications. The indications for operation may be considered with regard to (1) chronic middle-ear suppuration and (2) non-suppurative middle-ear disease, whether the result of a previous middle-ear suppuration or of a chronic middle-ear catarrh.
In chronic middle-ear suppuration, the chief object of the operation is to ensure drainage and if possible to remove the cause of the suppuration; in non-suppurative conditions, to improve the hearing.
Fig. 198. To show Sites of Perforation in Attic Suppuration and Caries of the Ossicles. 1. Perforation in front of malleus. 2. Perforation behind malleus. 3. Perforation involving posterior attic region and upper posterior part of membrane. (From the Author’s Diseases of the Ear.)
It may here be mentioned that the position of the perforation in the attic region is frequently of importance when considering the question of treatment. If situated in front of the malleus, the disease is probably limited to the outer attic region and malleus; if just behind the malleus, then probably both the malleus and incus are affected; but if the perforation extends farther back, involving the upper posterior quadrant of the drum, especially its bony margin, it suggests disease not only of the ossicles together with the walls of the aditus and antrum, but perhaps also of the mastoid process (Fig. 198).