Surgical Management and Hearing Outcome of Traumatic Ossicular Injuries

Abstract

OBJECTIVE:The purpose of this study was to investigate etiological, clinical, and pathological characteristics of traumatic injuries of the middle ear ossicular chain and to evaluate hearing outcome after surgery. MATERIAL AND METHODS:Thirty consecutive patients (31 ears) with traumatic ossicular injuries operated on between 2004 and 2015 in two tertiary referral otologic centers were retrospectively analyzed. Traumatic events, clinical features, ossicular lesions, treatment procedures, and audiometric results were evaluated. Air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were analyzed preoperatively and postoperatively. Amsterdam Hearing Evaluation Plots (AHEPs) were used to visualize the individual hearing results. RESULTS:The mean age at the moment of trauma was 27.9±17.1 years (range, 2-75 years) and the mean age at surgery was 33.2±16.3 years (range, 5-75 years). In 10 cases (32.3%), the injury occurred by a fall on the head and in 9 (29.0%) by a traffic accident. Isolated luxation of the incus was observed in 8 cases (25.8%). Dislocation of the stapes footplate was seen in 4 cases (12.9%). The postoperative ABG closure to within 10 and 20 dB was 30% and 76.7%, respectively. CONCLUSION:Ossicular chain injury by direct or indirect trauma can provoke hearing loss, tinnitus, and vertigo. As injuries are heterogeneous, they require a tailored surgical approach. In this study, the overall hearing outcome after surgical repair was favorable.

Surgical reconstruction of the ossicular chain with custom 3D printed ossicular prosthesis

“…Nevertheless, technical factors such as imprecise sizing and placement also play a significant role [ 10 ]. These data are supported by the observation that outcomes are not significantly better, if at all, for reconstruction following traumatic ossicular discontinuity, [ 11 , 12 ] a situation in which chronic infection and Eustachian tube dysfunction are not usually a factor. CT-based, custom 3D printed prostheses should minimize the impact of these variables, and consequently increase success rates.…”

“…However, none of these fully accounts for persisting air-bone gaps following ossiculoplasty [ 9 , 10 ]. That these factors do not fully account for the failure rates is also implied by the fact that similar results are obtained with ossicular chain reconstruction following middle ear trauma, a situation in which most of those factors are not an issue [ 11 , 12 ]. Some degree of hearing loss can be attributable to the design of current prostheses, which do not capture all of the mechanical advantages of the normal ossicular chain.…”

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

“…Ossiculoplasty was the main treatment for TOD, which was traditionally performed under microscope [1,2,9]. In recent years, EES for tympanoplasty and ossiculoplasty has increased annually, showing some obvious advantages, such as a wider and multiangle eld of view which allowed the surgeons to accurately assess and then reconstruct the ossicular chain [5][6][7][8].…”

“…Endoscopic ear surgery (EES) is becoming popular in the last decade, which is identical with microscopic ear surgery (MES), However, EES showed some obvious advantages, such as a wider surgical view and less invasive incision from the external auditory canal [5][6][7], the advantages of EES seem to be especially remarkable in minimally invasive middle ear surgery, such as ossiculoplasty [6,8]. However, up to date, most TOD were treated by ossiculoplasty under microscope [1,2,9]. Moreover, TOD is usually accompanied with temporal bone fracture (TBF) and facial nerve (FN) injury in some patients [10,11], whether the exclusive ESS could be quali ed to manage these complex injuries is unknown.…”

Misplaced incus: an unusual complication of a temporal bone fracture

“…Compared with the malleoincudal joint, the stapedial arch and the annular ligament, the incudostapedial joint is the joint least tolerant to external physical stresses 4. The incus is the most commonly dislocated of all the ossicles,5 owing to the absence of a muscular attachment and the heavy weight of the incus as compared with the malleus and stapes 2 6…”