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Abstract
Traumatic fracture of the stapes occurs rarely following head injury. Ossicular dislocation is more commonly encountered. When present, stapes fractures are usually associated with an underlying temporal bone fracture. A higher incidence has been reported in childhood, possibly because of the greater flexibility of the skull in this age group. This report highlights the fact that these fractures can be associated with a relatively minor head injury. This possibility should be kept in mind when evaluating patients, especially children, who have a persistent conductive deafness of more than 30 dB with an intact tympanic membrane following any form of head injury. An exploratory tympanotomy with appropriate ossicular reconstruction, as described in this case, can yield excellent results.
Key words: Head Injuries, Closed; Ear, Middle; Stapes; Fracture; Ossicular Prosthesis
Introduction
Blunt trauma to the skull can result in fractures of the temporal bone involving the external auditory canal, middle-ear structures, and otic capsule. The most common form of such fractures is a longitudinal fracture of the temporal bone. These commonly occur as a result of direct lateral blunt trauma to the parietal region of the head and result in ossicular damage. Transverse fractures are more commonly associated with a blow to the front or back of the skull and often result in sensorineural deafness due to underlying damage to the vestibule and cochlea.
Dislocation of the incudo-malleolar and incudo-stapedial joints are more common than isolated fractures of the ossicles. Fractures of the stapes suprastructure are relatively rare. The exact mechanism of stapes fracture is very complicated and depends on the direction and force of fracture lines in the skull.1 It has been shown that there is a relatively higher incidence of stapes fracture in childhood.2 This is generally attributed to increased flexibility of the child's skull although no clear cut explanation is found in the medical literature.
Case report
A 15-year-old boy fell off a skateboard striking his occiput against the kerb. He had mild bleeding from his left ear, that settled conservatively. There was no associated loss of consciousness. He noticed left-sided deafness but denied any tinnitus or vertigo. On examination, the left external auditory canal contained a blood...