Tympanometry and isolated fracture of the stapes

Numerical models of the human middle ear have been developed throughout the last 30 years, for different purposes. While several types of pathologies have been studied, stapedial disorders were seldomly explored. This papers aims to clarify how stapes fracture and some forms of stapes ankylosis, such as stapedial tendon (ST) ossification, augmented pyramidal eminence (PE) and bony bar presence, affect the sound transmission through the middle ear. In addition, the stapes dynamics is also analyzed by means of total displacement and first principal strain. For the purpose of the study, first, a three-dimensional finite element model of the human middle ear is detailed and validated under normal (healthy) conditions. The model is then modified to represent the stapedial disorders of interest. A measure is established for evaluating how the disorders reduce sound transmission through the middle ear. Results of the reduction of sound transmission showed that the different forms of stapes ankylosis affect primarily low frequencies, while the stapes fracture mostly affects high frequency sound transmission. According to the results, an augmented PE does not restrict stapes movement unless followed by some ossification of the ST. In addition, the question whether the fracture is in the anterior or posterior crus and the distance of the fractured part from the stapes footplate have a relevant role in the reduction of the sound transmission. Finally, the analysis of total displacement and first principal strain of the stapes helped to highlight some differences among the stapedial disorders.

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Traumatic Stapes Luxation into the Vestibule

Lee

2022

Ear Nose Throat J

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We report a rare case of traumatic stapes luxation into the vestibule. A 31-year-old female visited an emergency room with sudden onset of vertigo and conductive hearing loss after accidental penetrating injury to the right ear. Temporal bone computed tomography detected pneumolabyrinth, with a shade of whole intact stapes in the vestibule. Under exploratory tympanotomy, we observed a separated incudostapedial joint, and the stapes was depressed into the vestibule. The stapes was pulled out to the middle ear, and stapedectomy was performed; the crus were cut, the suprastructure was removed, and the fractured footplate and the long process of the incus were connected with a piston wire. The stapes footplate was sealed with soft tissue and surgical glue. Vertigo rapidly subsided after surgery, and hearing was improved to normal range. However, hearing loss at high frequencies was not recovered, probably because of inner ear damage due to the stapes depressed into the vestibule or surgical manipulation within the vestibule. Traumatic ossicular dislocation is not an uncommon occurrence in otolaryngologic practice, but stapes luxation is rare. Here, we report a rare case with successful repair. This report could serve as a basis for proper treatment in similar cases in the future.

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Tympanometry and isolated fracture of the stapes

Cited by 3 publications

References 6 publications

Nonlinear dynamic response and stability analysis of the stapes reconstruction in human middle ear

Nonlinear dynamic response and stability analysis of the stapes reconstruction in human middle ear

How Stapes Ankylosis and Fracture Affect Middle Ear Dynamics: A Numerical Study

Traumatic Stapes Luxation into the Vestibule

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