Learning Objectives: We reveal the appropriate surgical approach for a malleus ankylosis.

Introduction: The malleus ankylosis is known as a cause of congenital hearing loss. The limitation of the motion of malleus is due to the attachment of the head of malleus to the wall of epitympanum. In this reported, we presented two cases of malleus ankylosis who underwent the tympanoplasty.

Case1: The case was 18-year-old male. He noticed left hearing loss at the age of 4. He had been referred to our department for hearing examinations at the age of 8. Audiometry showed left conductive hearing loss. CT showed the fusion of the head of malleus and the wall of epitympanum in left side. He underwent left type I tympanoplasty, and got an effective hearing level. However, after 6 months, the hearing level in the left ear was the same as preoperative one. The recurrence of fixation of the malleus head was suspected.

Case2: The case was 9-year-old girl. She had recurrent otitis media at the age of 3. Though her otitis media was improved, she had still left conductive hearing loss. Thus, she had been referred to our department at the age of 6. CT showed the fusion of the head of malleus and the wall of epitympanum in left side. She underwent left type IIIc tympanoplasty, and got an effective hearing level.

Conclusion: It was suggested that type IIIc tympanoplasty is more appropriate approach for a malleus ankylosis than type I tympanoplasty.