Persistent Stapedial Artery, Facial Nerve Overhang, and Calcified Stapedius Tendon Leading to Aborted Stapedotomy: An Unusual Middle Ear Anatomy

This report describes a rare medical case of a 16-year-old girl with progressive bilateral hearing loss over nine years. Despite normal external ear anatomy, tests revealed moderate conductive hearing loss. Surgery uncovered an unusual persistent stapedial artery and ossified stapedial tendon with an overhang of the facial nerve over the oval window obscuring it and preventing the planned stapedotomy. Post-surgery, the patient had mild earache but no serious complications and was treated with antibiotics and steroids. She is scheduled for a hearing aid trial. This is the first known report of this exact triad occurring together, posing significant surgical implications. The case underscores the need for detailed preoperative imaging and careful surgical techniques to manage anatomical variations and improve outcomes in middle ear surgeries.