Ultrastructural changes of stapedius muscle and stapedius branch nerve endings in otosclerotic patients.

We studied in the electron microscope 12 stapedius muscles and stapedius branches of the facial nerve excised from otosclerotic patients who underwent stapedectomy for hearing restoration. Almost all of the stapedius, muscles demonstrated morphological alterations, such as accumulation of lipids and osmiophilic material, dilatation of the sarcoplasmic reticulum, sarcoplasmic invaginations of the nuclei and accumulation of fibroblasts and satellite cells on the surface of the muscle fibers. The stapedius branch of the facial nerve demonstrated a marked loss of myelinated fibers. Most of the unmyelinated or demyelinated fibers were surrounded by thick processes of the Schwann cell. The axons showed a paucity of neurofilaments and the nerve endings showed a rough dilatation of the cisternae of the smooth endoplasmic reticulum as well as accumulation of osmiophilic material. The morphological alterations of the stapedius muscle and the stapedius branch of the facial nerve in otosclerosis suggest that in addition to the lesions of the bone at various areas of predilaction, a substantial pathological alteration of the muscle and nerve fibers also occurs in the middle ear adjacent or distal to otosclerotic foci, a fact that enlarges the concept of the pathological spectrum of the disease.