The bucket handle is flipped over the long process and the mechanical action of the prosthesis checked by gentle palpation (Fig. 15-14). If it is difficult to fit the bucket handle, it should be left alone. It should not be forced onto the incus. Too tight a fit prevents the prosthesis from centering. Blood is gently suc-tioned away and the tympanic membrane replaced. An intraoperative air threshold audiogram is obtained. This is a qualitative test only. The patient is expected to hear better, but not at the final level. It is

FIGURE 15-13 An incus hook is bent and placed under and behind the incus, to steady it and to lift it ever so gently.
FIGURE 15 —14 The bucket handle is placed over the incus if possible. The mobility of the whole assembly is checked using a blunt instrument.

important not to expect too much of this test. Ideally, the hearing should be within 15 dB of the preopera-tive bony threshold. If it is not improved, the drum is lifted and a cause sought for the failure to improve. Antibiotic ointment is used to fill the external canal and the patient returned to the recovery room.

Complications of Stapedectomy

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