Abstract
Stapediovestibular dislocation is an unusual form of ossicular trauma. In this article, a case of medial stapediovestibular dislocation and pneumolabyrinth due to penetrating injury with a stick diagnosed on temporal bone CT is described. In particular, 3D CT renderings can aid in the evaluation of the displaced ossicles.
A 66-year-old female fell and a stick entered the left external auditory canal, resulting in a loud popping sound, bloody otorrhea, dizziness, and hearing loss. Otomicroscopic examination demonstrated a well healed intact tympanic membrane and aerated middle ear. The Weber test lateralized to the right at 512 Hz and the Rinne was negative on the left. An audiogram demonstrated a flat 80 dB mixed hearing loss with decline in both air and bone conduction thresholds and word recognition score of 8% in the left ear. Temporal bone CT ( Fig. 1 ) demonstrated extensive pneumolabyrinth and substantial medial displacement of the stapes into the vestibule. A 3D CT rendering also depicted medial displacement of the stapes through the oval window and showed that the attachment of the stapes with the incus was preserved ( Fig. 2 ). The patient subsequently underwent exploratory tympanotomy, which confirmed the complete subluxation of the stapes into the vestibule and otherwise intact ossicular chain. Surgical repair of perilymphatic fistula and total stapedectomy was performed, resulting in complete resolution of her problems with dizziness and disequilibrium. The patient also received oral steroids using a sudden sensorineural hearing loss protocol consisting of Prednisone 60 mg once daily for two weeks followed by a taper of 10 mg per day over five days.
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