Delayed surgical treatment of traumatic hearing loss due to ossicular disruption

Surgical treatment of dislocation and fracture of the middle ear ossicles is recommended to be carried out within months of the initial injury. Here we present 6 patients with traumatic ossicular injury whose surgery was delayed over 1 year. We evaluated the clinical and pathological changes that occurred over time and assessed the surgical outcomes in delayed cases.

Histories of the causative traumas, computerized tomography (CT) and tympanometry findings, pre- and postoperative hearing thresholds, and ossicular damages assessed at the tympanotomies were evaluated.

The time lapse between the trauma and the surgery varied from 1 to 6 years. The resultant hearing losses were moderate or moderately severe, conductive, mixed or sensorineural type. Tympanometry and CT revealed ossicular discontinuity in only two cases. In operations, various types of ossicular abnormalities in the form of absence, displacement, fracture and/or fixation were identified. Continuity and mobility of the ossicular chains were restored with various techniques. Air-bone conduction gap was brought to within 20 dBHL in all cases, and within 10 dB in 3 (50%) of the cases. Gains in the bone conduction were also notable.

Trauma to the middle ear may result in an elevation in the air and/or bone conduction thresholds due to ossicular disruption and fixation. Our findings confirmed that tympanotomy is superior to methods such as CT and tympanometry in delineating the type and extent of the traumatic ossicular damage, and usually gives favorable results even in delayed cases.