You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Treatment of Traumatic Stapediovestibular Luxation: Case Report With the Introduction of a New Technique and Review of Literature

Bogaerts, Marie; Waterval, Jérôme; van Dinther, Joost; Somers, Thomas; Zarowski, Andrzej; Offeciers, Frans Erwin

Otology & Neurotology:
doi: 10.1097/MAO.0000000000000322
Review Article
Abstract

Objective: Stapediovestibular luxations are rare lesions that are most commonly caused by direct, penetrating trauma to the external ear canal. In this type of ossicular dislocation, disruption of the annular ligament or footplate fracture may lead to a perilymphatic fistula (PLF) presenting with cochleovestibular symptoms including (progressive) sensorineural hearing loss, tinnitus, and vestibular symptoms. The objective of this article is to define the optimal treatment of stapediovestibular luxations and review the literature on this topic.

Patient: We present a case of internal stapediovestibular dislocation and pneumolabyrinth after penetrating trauma with predominantly conductive hearing loss and incapacitating vertigo.

Intervention: Middle ear inspection with removal of the luxated incus, repositioning of the stapes with a “stapedial strut” and closure of the tympanic membrane.

Main outcome measures: Hearing outcome and vestibular symptoms of this patient are presented, and all comparable cases in the literature are reviewed.

Results: Complete resolution of the vestibular symptoms and stabilization of the bone conduction thresholds.

Conclusion: In patients with pneumolabyrinth after middle ear trauma with mild symptoms, we recommend initial conservative treatment with close monitoring of hearing. In patients with severe, persisting, or progressive vestibulocochlear symptoms, exploratory tympanotomy should be performed to check for and treat PLF. Oval window fistula repair is reported to have variable hearing outcomes but offers complete resolution of vestibular symptoms in most cases. The stapedial strut is one of the possible surgical techniques in case of an internally luxated stapes.

Author Information

European Institute for Otorhinolaryngology, Wilrijk, Antwerp, Belgium

Address correspondence and reprint requests to Marie Bogaerts, M.D., European Institute for Otorhinolaryngology, Oosterveldlaan 24, 2610 Wilrijk, Antwerp, Belgium

Presented at the Flemish-Dutch Otologic Society.

Marie Bogaerts and Jérôme Waterval shared first authorship.

The authors declare no conflicts of interest.

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company