scholarly journals Misplaced incus: an unusual complication of a temporal bone fracture

2019 ◽  
Vol 12 (3) ◽  
pp. e228207
Author(s):  
Katherine Pollaers ◽  
Christopher Broadbent ◽  
Jafri Kuthubutheen
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Ossicular Chain ◽  
Unusual Complication ◽  
Temporal Bone Fracture ◽  
Patient Reported ◽  
Ossicular Chain Reconstruction ◽  
Hearing Outcomes ◽  
Conductive Hearing

A 24-year-old man sustained significant injuries as a result of a motor bicycle accident. CT scans demonstrated multiple intracranial injuries including bilateral temporal bone fractures. On emergence from sedation, the patient reported right-sided hearing loss which was attributed to ossicular chain disruption after the incus was found to be in the external auditory canal. Unexpectedly, the initial conductive hearing loss resolved with conservative management and an ossicular chain reconstruction was not required. This is an unusual case of impressive long-term good hearing outcomes following complete dislocation of the incus and extrusion from the middle ear.

scholarly journals Hearing and Mortality Outcomes following Temporal Bone Fractures

2017 ◽  
Vol 10 (4) ◽  
pp. 281-285 ◽  
Author(s):  
Adam Honeybrook ◽  
Aniruddha Patki ◽  
Nikita Chapurin ◽  
Charles Woodard
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Conductive Hearing Loss ◽  
Bone Fractures ◽  
Ossicular Chain ◽  
Otic Capsule ◽  
Temporal Bone Fracture ◽  
Longitudinal Fractures ◽  
Conductive Hearing

The aim of this article is to determine hearing and mortality outcomes following temporal bone fractures. Retrospective chart review was performed of 152 patients diagnosed with a temporal bone fracture presenting to the emergency room at a tertiary care referral center over a 10-year period. Utilizing Patients’ previously obtained temporal bone computed tomographic scans and audiograms, fractures were classified based on several classification schemes. Correlations between fracture patterns, mortality, and hearing outcomes were analyzed using χ2 tests. Ossicular chain disruption was seen in 11.8% of patients, and otic capsule violation was seen in 5.9%; 22.7% of patients presented for audiologic follow-up. Seventeen patients with conductive hearing loss had air–bone gaps of 26 ± 7.5 dB (500 Hz), 27 ± 6.8 dB (1,000 Hz), 18 ± 6.2 dB (2,000 Hz), and 32 ± 7.7 dB (4,000 Hz). Two cases of profound sensorineural hearing loss were associated with otic capsule violation. No fracture classification scheme was predictive of hearing loss, although longitudinal fractures were statistically associated with ossicular chain disruption ( p < 0.01). Temporal bone fractures in patients older than 60 years carried a relative risk of death of 3.15 compared with those younger than 60 years. The average magnitude of conductive hearing loss resulting from temporal bone fracture ranged from 18 to 32 dB in this cohort. Classification of fracture type was not predictive of hearing loss, despite the statistical association between ossicular chain disruption and longitudinal fractures. This finding may be due to the low follow-up rates of this patient population. Physicians should make a concerted effort to ensure that audiological monitoring is executed to prevent and manage long-term hearing impairment.

scholarly journals Endoscopic Ear Surgery for the Management of Traumatic Ossicular Disruption with Intact Tympanic Membrane

2020 ◽  
Author(s):  
Chunlin Zhang ◽  
Dan Long ◽  
Yuan Deng ◽  
Mei Ynag ◽  
Dandan Guo ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Retrospective Study ◽  
Conductive Hearing Loss ◽  
Ossicular Chain ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery ◽  
Temporal Bone Fracture ◽  
Hearing Outcomes ◽  
Conductive Hearing ◽  
Facial Function

Abstract Background Traumatic ossicular disruption (TOD) usually had a severe conductive hearing loss, the exploratory tympanotomy is critical for the diagnosis and improve hearing. Endoscopic ear surgery (EES) is becoming popular in the last decade, we conducted a retrospective study to explore the efficacy of EES for management of TOD and the accompanied injuries.Methods A retrospective study was performed on 18 ears (16 patients) of TOD with intact TM from May 2017 to Jun 2019 in our department. EES was conducted to check the ossicular chain anomalies, and to perform the ossiculoplasty and facial nerve (FN) decompression depending on the intraoperative findings. Hearing outcomes and surgical complications were assessed at 6 months postoperatively. Results The incus injury was the most common type of TOD, which was observed in 14 ears (77.8%), stapes suprastructure fracture was observed in 4 ears (22.2%). FN injury was found in 4 out of 13 ears with temporal bone fracture (TBF), the injury sites were mainly located in the perigeniculate area and the tympanic segment of FN. It showed the postoperative average pure-tone average (PTA) gain was 22.9 ± 9.5 dB, and the average ABG closure was 22.2 ± 8.3 dB, ABG closure to 20 dB or less and ABG closure to 10 dB or less were achieved in 18 ears (100%) and 14 ears (77.8%), respectively. The facial function achieved favorable recovery of House-Brackmann (H-B) grade Ⅰ (3 ears) and grade Ⅱ (1 ear) in all the 4 cases in 6 months after surgery. No iatrogenic FN paralysis and significant sensorineural hearing loss were observed. Conclusions ESS was effective in diagnosis and management of TOD and the accompanied otologic injuries, such as FN paralysis, it showed favorable surgical outcomes. ESS provides an alternative method to manage TOD with the advantage of excellent vision and less invasion.

Ossicular Discontinuity and Exostoses in Proteus Syndrome: A Case Report

2005 ◽  
Vol 114 (3) ◽  
pp. 242-246
Author(s):  
Joni K. Doherty ◽  
Dennis R. Maceri
Keyword(s):  
Hearing Loss ◽  
High Frequency ◽  
Conductive Hearing Loss ◽  
Ossicular Chain ◽  
Typical Feature ◽  
Proteus Syndrome ◽  
Frequency Range ◽  
Pure Tone Average ◽  
Ossicular Chain Reconstruction ◽  
Conductive Hearing

Proteus syndrome (PS) is a rare hamartomatous disorder characterized by mosaic overgrowth of multiple tissues that manifests early in life and is progressive. The presence of unilateral external auditory canal exostoses in a patient who is not a swimmer or surfer is suggestive of PS. However, hearing loss is not a typical feature. Here, we describe exostoses and ossicular discontinuity with conductive hearing loss in a patient with PS. The treatment consisted of canalplasty and ossicular chain reconstruction. A postoperative reduction was demonstrated in the patient's air-bone gap, from 21 dB to 13 dB for the pure tone average (four frequencies) and from 41 dB to 15 dB in the high-frequency range (6,000 to 8,000 Hz). Causes of ossicular discontinuity are discussed. Routine annual audiometric and otolaryngological evaluation should be considered in all patients with temporal bone inyolvement of PS.

Comparison of the application of artificial ossicles and autologous ossicles in the reconstruction of a damaged ossicular chain

2018 ◽  
Vol 132 (10) ◽  
pp. 885-890
Author(s):  
L Zhao ◽  
J Li ◽  
S Gong
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Pure Tone ◽  
Bone Fractures ◽  
Pure Tone Audiometry ◽  
Ossicular Chain ◽  
Facial Nerve Paralysis ◽  
Temporal Bone Fracture ◽  
Nerve Paralysis ◽  
Ossicular Reconstruction

AbstractObjectiveTo evaluate the therapeutic effect that the titanium partial ossicular reconstruction prosthesis and autologous ossicles have on hearing loss after reconstruction of a damaged ossicular chain.MethodsForty-two medical records of treatments carried out from 2013 to 2015 for ossicular chain damage with facial nerve paralysis due to temporal bone fractures were reviewed. The study assessed: causes of damage, pre-operative pure tone audiometry findings, types of intra-operative ossicular chain damage, intra-operative ossicular chain repair methods (titanium partial ossicular reconstruction prosthesis or autologous ossicles) and post-operative pure tone audiometry results.ResultsThe titanium partial ossicular reconstruction prosthesis was used in 26 cases; the average air–bone gap was 32.3 ± 5.3 dB pre-operatively and 12.8 ± 5.3 dB post-operatively. Autologous ossicles were used in 16 cases; the average air–bone gap was 33.4 ± 4.5 dB pre-operatively and 17.8 ± 7.8 dB post-operatively.ConclusionOssicular chain reconstruction is an effective way of improving hearing in patients with ossicular chain damage. The results suggest that repair with either the titanium partial ossicular reconstruction prosthesis or autologous ossicles can improve hearing following ossicular chain injury with facial nerve paralysis caused by a temporal bone fracture.

scholarly journals Traumatic dislocation of middle ear ossicles: A new computed tomography classification predicting hearing outcome

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245796
Author(s):  
Georgios Mantokoudis ◽  
Njima Schläpfer ◽  
Manuel Kellinghaus ◽  
Arsany Hakim ◽  
Moritz von Werdt ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Outcome Prediction ◽  
Conductive Hearing Loss ◽  
Bone Fractures ◽  
Ct Scans ◽  
Axis Deviation ◽  
Joint Dislocation ◽  
Hearing Outcome ◽  
Conductive Hearing

Objectives To assess the feasibility of radiologic measurements and find out whether hearing outcome could be predicted based on computer tomography (CT) scan evaluation in patients with temporal bone fractures and suspected ossicular joint dislocation. Methods We assessed 4002 temporal bone CT scans and identified 34 patients with reported ossicular joint dislocation due to trauma. We excluded those with no proven traumatic ossicular dislocation in CT scan and patients with bilateral temporal bone fractures. We measured four parameters such as malleus-incus axis distance, malleus-incus angle at midpoints, malleus- incus axis angle and ossicular joint space. The contralateral healthy side served as its own control. Hearing outcome 1–3 months after the index visit was analyzed. We assessed diagnostic accuracy and performed a logistic regression using radiologic measurement parameters for outcome prediction of conductive hearing loss (defined as >20dB air-bone gap). Results We found excellent inter-rater agreement on the measurement of axis deviation between incus and malleus in CT scans (interclass correlation coefficient 0.81). The larger the deviation of incus and malleus axis, the higher probability of poor hearing outcome (odds ratio (OR) 2.67 per 0.1mm, p = .006). A cut-off value for the axis deviation of 0.25mm showed a sensitivity of 0.778 and a specificity of 0.94 (p < .001) for discrimination between poor and good hearing outcome in terms of conductive hearing loss. Conclusion Adequate assessment of high resolution CT scans of temporal bone in which ossicular chain dislocation had occurred after trauma was feasible. Axis deviations of the incus and the malleus were strongly predictive for poor hearing outcome in terms of air conduction 1–3 months after trauma. We propose a 3-level classification system for hearing outcome prediction based on radiologic measures.

scholarly journals Revisión bibliográfica de la detección temprana de luxación incudomaleolar mediante imágenes tomográficas

Medunab ◽  
2016 ◽  
Vol 18 (3) ◽  
pp. 213-217
Author(s):  
Lady Yadira Reyes-Álvarez ◽  
Federico Lubinus-Badillo ◽  
Evelyn Zuñiga-Hadechni ◽  
Ilich Fabián Plata-Cano ◽  
Jean Fabio Plata-Cano
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Conductive Hearing Loss ◽  
Bone Fractures ◽  
Calidad De Vida ◽  
Ear Ossicles ◽  
Conductive Hearing

Introducción: Esta revisión hace énfasis en la luxación incudomaleolar. Aunque poco frecuente, es una patología con gran relevancia clínica debido a la afectación de la audición a corto y mediano plazo en los pacientes, afectando así su calidad de vida, por lo que es necesario un diagnóstico oportuno para un tratamiento temprano y eficaz. Objetivo: describir los hallazgos imagenológicos e identificar los diferentes mecanismos etiológicos de la luxación incudomaleolar. Metodología: Se realizó una revisión bibliográfica en PubMed de los artículos publicados hasta febrero de 2015 con las palabras claves: “Ear ossicles”; “Temporal bone”; “Bone”; “Fractures”; “Dislocation”; “Conductive hearing loss”. Se encontraron 352 artículos de los cuales se seleccionaron aquellos donde se menciona la luxación incudomaleolar. Resultados: Se revisaron los abstracts de los 352 artículos, encontrando 20 donde mencionaban la definición, la epidemiología, la clínica y el diagnóstico imagenológico de la luxación incudomaleolar, los cuales fueron utilizados para la elaboración de esta revisión. Conclusiones: La principal causa de daño en la cadena de huesecillos es la fractura del hueso temporal y dentro de las patologías que puede generar está la luxación incudomaleolar, por lo que es de interés el diagnóstico temprano a todos los pacientes con sospecha clínica para llegar a prevenir complicaciones. La revisión de la literatura permite concluir que la técnica más eficaz para la identificación de la luxación Incudomaleolar es la tomografía computarizada, la cual requiere una adecuada identificación en los diferentes cortes multiplanares, o en las reconstrucciones 3D para poder diagnosticarla. [Lubinus-Badillo F, Zuñiga-Hadechni E, Reyes-Álvarez LY, Plata-Cano IF, Plata-Cano JF. Revisión bibliográfica de la detección temprana de luxación incudomaleolar mediante imágenes tomográficas. MedUNAB 2016; 18(3): 213-217].

scholarly journals Contralateral Cochlear Labyrinthine Concussion without Temporal Bone Fracture: Unusual Posttraumatic Consequence

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
I. M. Villarreal ◽  
D. Méndez ◽  
J. M. Duque Silva ◽  
P. Ortega del Álamo
Keyword(s):  
Hearing Loss ◽  
Head Injury ◽  
Sensorineural Hearing Loss ◽  
Temporal Bone ◽  
Head Trauma ◽  
Bone Fractures ◽  
Contralateral Side ◽  
Sensorineural Hearing ◽  
Temporal Bone Fracture ◽  
Blunt Head Trauma

Introduction. Labyrinthine concussion is a term used to describe a rare cause of sensorineural hearing loss with or without vestibular symptoms occurring after head trauma. Isolated damage to the inner ear without involving the vestibular organ would be designated as a cochlear labyrinthine concussion. Hearing loss is not a rare finding in head trauma that involves petrous bone fractures. Nevertheless it generally occurs ipsilateral to the side of the head injury and extraordinarily in the contralateral side and moreover without the presence of a fracture.Case Report. The present case describes a 37-year-old patient with sensorineural hearing loss and tinnitus in his right ear after a blunt head trauma of the left-sided temporal bone (contralateral). Otoscopy and radiological images showed no fractures or any abnormalities. A severe sensorineural hearing loss was found in his right ear with a normal hearing of the left side.Conclusion. The temporal bone trauma requires a complete diagnostic battery which includes a neurotologic examination and a high resolution computed tomography scan in the first place. Hearing loss after a head injury extraordinarily occurs in the contralateral side of the trauma as what happened in our case. In addition, the absence of fractures makes this phenomenon even more unusual.

scholarly journals Incudostapedial joint dislocation with conductive hearing loss: a case report

2019 ◽  
Vol 5 (3) ◽  
pp. 797
Author(s):  
Preeti Dhingra ◽  
Ashutosh Pusalkar
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Temporal Bone ◽  
Conductive Hearing Loss ◽  
Titanium Implant ◽  
Ossicular Chain ◽  
Common Complication ◽  
Joint Dislocation ◽  
Incudostapedial Joint ◽  
Conductive Hearing

<p class="abstract">Trauma to the ossicular chain is a common complication of fracture temporal bone, ossicular dislocation being more common than ossicular fracture. Most commonly affected ossicles are the incus and malleus, stapes being relatively more stable. The most common injury is the incudostapedial joint dislocation. We are presenting a case of unilateral conductive hearing loss in a patient with the pre operative diagnosis of otosclerosis, which intra-operative turned out to be incudostapedial joint dislocation with malleus fixation, successfully reconstructed with partial titanium implant.</p>

scholarly journals Hearing loss following temporal bone fractures- a study on classification of fractures and the prognosis

2017 ◽  
Vol 3 (2) ◽  
pp. 390
Author(s):  
Nagaraj Maradi ◽  
Somanath B. M.
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Bone Fracture ◽  
Bone Fractures ◽  
Tertiary Care ◽  
Classification Systems ◽  
Otic Capsule ◽  
Care Hospital ◽  
Temporal Bone Fracture ◽  
Traditional System

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Temporal bone fractures are traditionally classified as transverse, longitudinal or mixed fractures depending on their relationship to the petrous pyramid. However recent studies show that classifying temporal bone fractures as otic capsule sparing (OCS) and otic capsule violating (OCV) types has more relevance with the prognosis of hearing loss and other associated complications. To assess the predictive value of two different types of temporal bone fracture classification systems with respect to hearing loss and its type.</span></p><p class="abstract"><strong>Methods:</strong> This prospective study was done on patients attending a tertiary care hospital in the study period of one year. Temporal bone fracture patients satisfying inclusion and exclusion criteria were clinically and audiologically evaluated. All patients with temporal bone fractures were categorized into two groups - Longitudinal/ Transverse (old) and OCS / OCV (new). <span lang="EN-IN">Hearing loss was evaluated audiologically on multiple intervals- initially following the injury once the patient is stable, later after a gap of 1 month and 3 months following the injury. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">During the study period, 45 patients presenting with temporal bone fractures who satisfied the selection criteria were evaluated. The correlation was statistically significant for new classification system (<em>P</em>- 0.000) with respect to severity and prognosis of hearing loss which was not the case with the old system (<em>P</em>- 0.450). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We found that classifying temporal bone fractures into OCV and OCS correlates well with the severity of the hearing loss, the prognosis of the patient and the residual hearing disability when compared to the traditional system.</span></p>

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