Tympanometry and isolated fracture of the stapes

Temporal bone fractures are frequently associated with ossicular dislocations or fractures, most commonly involving the incus. To our knowledge, isolated fracture of the posterior crus of the stapes has not been previously reported.

A 20-year-old man consulted for persistent left hypoacusis several months after a head injury. Initial computed tomography of the temporal bone showed a simple temporal bone fracture with no other associated abnormalities. The diagnosis of stapes fracture was suggested by increased compliance on tympanometry, leading to a second thin-section temporal bone computed tomography, which suggested a fracture of the posterior crus of the stapes. Endaural surgical exploration confirmed the diagnosis and allowed placement of ionomer cement in the posterior crus.

The possibility of ossicular dislocation or fracture must be considered in patients with persistent conductive hearing loss associated with increased compliance on tympanometry, even when computed tomography of the temporal bone does not show dislocation of the ossicular chain or ossicular fracture. Hearing rehabilitation can be performed by hearing aid or surgical reconstruction of the ossicles.