Ossicular necrosis following head injury

The aim of this study is to report on ossicular necrosis in the middle ear occurring shortly after head injury.

Our sample included 3 males and 2 females aged 9 to 37 years who complained of unilateral hearing loss after a head trauma that had occurred 3 to 6 months previously. The tympanic membranes were intact, and a CT-scan did not show fracture of the temporal bone. Audiometry showed a unilateral conductive hearing loss in all cases.

On tympanotomy exploration, 4 of the 5 patients had a necrosis of the lenticular process of the incus and one patient had a necrosis of the posterior and anterior crura of the stapes. Additionally, the incus was displaced at the incudomalleolar joint towards the promontory in two patients. The long process of the incus was surgically aligned and adjusted to the head of the stapes through interposition of either temporal fascia or a bone chip. At the 2-year-postoperative follow-up, the pure tone audiometry showed that the preoperative air-bone gap was almost closed with a mean of 11.8 dB.

It is possible that the head injury resulted in ossicular displacement in the middle ear with disturbance of the local vascular supply. Due to the tenuous blood supply to the lenticular and long processes of the incus, this portion of the ossicular chain, including the stapes suprastructure, may become more vulnerable to an ischemic process and subsequent necrosis shortly after the head trauma.