Absent stapedius muscle, tendon and pyramid – An anomaly revisited

Congenital absence of stapedius is an exquisite entity, with an incidence of 0.5% and very few cases reported in live patients. We herein report a case of a middle-aged female presented with bilateral ear discharge and decreased hearing for more than a year, which, on examination, showed a large central perforation bilaterally, and an audiogram preoperatively revealed an average hearing loss of 45 dB and air-bone gap of 35dB bilaterally. Right endoscopic type I tympanoplasty was done, which unveiled absent stapedius muscle, tendon, and pyramid on the right side. The absent stapedius should circumspect the operating surgeon to look for other associated anomalies such as tympanosclerosis, fixed footplate and aberrant course of the facial nerve.