Traumatic ossicular dislocations: etiology and management☆

Abstract 

Objective

This study was conducted to discuss the etiologic factors, clinical-radiologic findings, and surgical outcomes in patients with traumatic ossicular pathology.

Material and methods

Thirty-two patients with conductive hearing loss due to trauma were retrospectively analyzed. Their mean age was 24.56 ± 7 years. The average delay from injury until treatment was 5.7 years. Air and bone conduction hearing thresholds were measured by pure tone audiometry on initial admission, at 1 month postoperatively and during follow-up at 6-month intervals. Mean follow-up time is 3.2 years. The hearing threshold was calculated as the mean value of the threshold for 500, 1000, 2000, and 3000 Hertz. All patients were evaluated by high-resolution computerized tomography of the temporal bone at axial and coronal sections before the surgery.

Results

Traffic accident was the common cause of injury. Seven patients had temporal bone fracture. Six patients had facial paralysis ranging between House-Brackmann grades II and IV. Incudostapedial disarticulation was the most common ossicular pathology. Closure of air-bone gap within 10 and 20 decibels was observed in 37.6% and 71.9% of the patients, respectively. There is an improvement of 10 decibels or more in the hearing threshold of 27 (84.3%) patients.

Conclusions

Head trauma can be associated with ossicular disruption, which should be suspected in patients with conductive hearing loss that persists after a healing process of 2 months. The diagnosis can be best confirmed by tomography. Hearing results after immediate or delayed ossiculoplasty are apparently satisfying, although late cases are assumed to be associated with adhesion or fibrosis.