Traumatic dislocation of middle ear ossicles: A new computed tomography classification predicting hearing outcome

Abstract

Objectives To assess the feasibility of radiologic measurements and find out whether hearing outcome could be predicted based on computer tomography (CT) scan evaluation in patients with temporal bone fractures and suspected ossicular joint dislocation. Methods We assessed 4002 temporal bone CT scans and identified 34 patients with reported ossicular joint dislocation due to trauma. We excluded those with no proven traumatic ossicular dislocation in CT scan and patients with bilateral temporal bone fractures. We measured four parameters such as malleus-incus axis distance, malleus-incus angle at midpoints, malleus- incus axis angle and ossicular joint space. The contralateral healthy side served as its own control. Hearing outcome 1–3 months after the index visit was analyzed. We assessed diagnostic accuracy and performed a logistic regression using radiologic measurement parameters for outcome prediction of conductive hearing loss (defined as >20dB air-bone gap). Results We found excellent inter-rater agreement on the measurement of axis deviation between incus and malleus in CT scans (interclass correlation coefficient 0.81). The larger the deviation of incus and malleus axis, the higher probability of poor hearing outcome (odds ratio (OR) 2.67 per 0.1mm, p = .006). A cut-off value for the axis deviation of 0.25mm showed a sensitivity of 0.778 and a specificity of 0.94 (p < .001) for discrimination between poor and good hearing outcome in terms of conductive hearing loss. Conclusion Adequate assessment of high resolution CT scans of temporal bone in which ossicular chain dislocation had occurred after trauma was feasible. Axis deviations of the incus and the malleus were strongly predictive for poor hearing outcome in terms of air conduction 1–3 months after trauma. We propose a 3-level classification system for hearing outcome prediction based on radiologic measures.

Diagnosing Middle Ear Malformation by Pure-Tone Audiometry Using a Three-Dimensional Finite Element Model: A Case-Control Study

“…Modifications were made to the model proposed by Koike et al [6], which generated FE models of the damaged middle ear for theoretical research purposes. The FE method is a numerical analysis method to numerically obtain approximate solutions for differential equations that are difficult to solve analytically.…”

“…Given that over 80% of cases of conductive hearing loss can be attributed to conditions such as otitis media with cholesteatoma or chronic suppurative otitis media, the timely diagnosis of a congenital malformation or otosclerosis is often impeded. Similarly, delays in identifying traumatic injuries occur due to the high incidence of indirect injury [5,6]. Recognizing and comprehending the pathogenesis of ossicular chain defects are of paramount importance, as these defects can be rectified through surgical interventions.…”