Congenital middle ear anomalies: endoscopic outcomes, facial nerve anomalies, and bilateral consistency in 41 ears

Background Congenital middle ear anomalies are primarily managed surgically, but data on facial nerve anomalies and bilateral cases are limited.Objective To report endoscopic outcomes for congenital middle ear anomalies, focusing on facial nerve anomalies and bilateral consistency.Methods Retrospective review of 33 patients (41 ears) from 2021 to 2025. Anomalies were intraoperatively classified using the Teunissen system. All underwent endoscopic, class-specific ossicular reconstruction. Facial nerve anomalies recorded. Audiometric outcomes (ABG, 8 kHz) were analyzed. Complications recorded.Results The cohort had 57.6% unilateral and 42.4% bilateral cases. Facial nerve anomalies in 41.5% of ears. In all eight patients who underwent staged bilateral surgery, the ossicular and facial nerve patterns were identical between the two ears. Mean ABG improved from 39.7 ± 9.5 dB to 14.5 ± 5.4 dB (p < 0.001). Successful hearing (ABG ≤ 20 dB) achieved in 87.8% (Class I 80%, II 80%, III 95.2%, IV 80%). No sensorineural hearing loss (SNHL) or facial palsy.Conclusion Congenital middle ear anomalies are frequently associated with facial nerve malformations and may exhibit bilateral symmetry in staged cases, offering preoperative insight. An endoscopic, classification-based approach yielded encouraging hearing outcomes and a favorable safety profile, even with complex facial nerve anomalies. These findings are preliminary, limited by retrospective design and sample size.