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Background: Conductive hearing loss continue to remain undiagnosed in a large number of patients with intact membrane. Endoscope assisted tympanotomy provides an alternative technique for diagnosis and also facilitates treatment. Methods: A prospective analysis over a 5 year period of 72 exploratory tympanotomies for conductive hearing loss was performed in patients with intact tympanic membrane. Per operative findings were treated in the same sitting. Post-operative follow up of the patient was done up to 6 months. Results: The most common operative diagnosis was found to be otosclerosis (66%), followed by traumatic ossicular dislocation, tympanosclerotic patch, middle ear adhesions, foreign bodies etc. Small fenestra Stapedotomy with prosthesis insertion was the preferred surgical procedure performed in this study, resulting in perceptible hearing improvement post operatively. Conclusion: Endoscope assisted tympanotomy and associated middle ear surgeries serves as an effective diagnostic and therapeutic option. This study is of value in assessing the surgical challenges in diagnosis and definitive treatment for conductive hearing loss with an intact tympanic membrane.

We report on two cases of auditory ossicular anomaly and one case of traumatic ossicular dislocation evaluated with three-dimensional images using MDCT (multidetector-row CT). The first patient was an 18-year-old female, who had noticed hearing impairment in her right ear since she was a child. The second patient was a 32-year-old male, complaining of hearing loss in his right ear after a head injury. The third patient was a 27-year-old female who had hearing impairment in her right ear probably from birth. The first and the second patients underwent surgery, and their congenital ossicular anomaly and traumatic ossicular disarticulation were identified intraoperatively, which were almost corresponding to the findings shown by three-dimensional computed tomography (3D-CT). In both cases, the additional information provided by 3D-CT, together with conventional cross-sectional CT images, improved the ability to evaluate and diagnose the auditory ossicular lesions preoperatively. Although the third patient did not undergo surgery because she preferred observation, 3D-CT clearly showed the abnormality of her ossicles compared with conventional CT images, which helped her and her family to understand the reason for her hearing impairment. Our cases indicate that 3D-CT is useful not only for surgeons to optimize surgical planning but also for patients to understand the condition of their middle ear.