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The transmastoid approach is a frequently performed approach, but it remains unknown if this surgery is effective when the ossicular chain is preserved. This study aimed to determine the efficacy of facial nerve decompression using the transmastoid approach in Bell's palsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>This retrospective study included patients who had undergone transmastoid facial nerve decompression with ossicular chain preservation and patients who met the criteria for surgery, but received only medical treatment between January 2007 and May 2019, at a single centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Attainment of House\u2010Brackmann grade I at 12 months after onset of facial palsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The recovery rate to House\u2010Brackmann grade I in the decompression group in the early phase (\u226418\u00a0days after onset) was higher than that of the medical treatment group, although the difference was not significant (70% vs 47%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.160). However, within this early surgery group, a subgroup of cases with \u226595% facial nerve degeneration demonstrated a significant improvement in recovery rate (73% vs 30%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.018). Among surgeries performed in the late phase (\u226519\u00a0days), only a subgroup with \u226595% facial nerve degeneration was available for analysis, and the difference in recovery rate was not significant compared with medical treatment alone (26% vs 30%, <jats:italic>P<\/jats:italic>\u00a0=\u00a01.00). Post\u2010surgical hearing evaluation demonstrated that average hearing deterioration was 1.3\u00a0dB which was non\u2010significant, suggesting this procedure does not cause hearing loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Transmastoid facial nerve decompression with ossicular chain preservation in the early phase after symptom\u2010onset is an effective salvage treatment for severe Bell's palsy with \u226595% facial nerve degeneration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13671","type":"journal-article","created":{"date-parts":[[2020,11,25]],"date-time":"2020-11-25T07:51:53Z","timestamp":1606290713000},"page":"325-331","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Facial and hearing outcomes in transmastoid nerve decompression for Bell's palsy, with preservation of the ossicular 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