Traumatic ossicular dislocations: etiology and management.

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.