Case II: traumatic middle ear injury (R) - axial view

Case description

A 28-year-old female patient presented with a significant traumatic ear injury. At 18, she was urgently referred to our clinic due to bloody ear discharge post-temporomandibular joint arthroscopy. Initial examination revealed an anterior canal wall laceration and a traumatic tympanic membrane (TM) perforation. Audiometric tests indicated moderate conductive hearing loss, characterized by a \( 32.5 \, \text{dB} \) mean air-bone gap across \( 0.5 - 4 \, \text{kHz} \) frequencies. Despite the TM perforation healing, the conductive hearing loss remained. The patient declined surgical intervention but continues to be monitored by our clinic. Her ear's condition is unchanged since the initial injury. A recent examination of the healed TM revealed a nearly featureless structure, with the lateral process of the malleus (M) being the only distinguishable landmark under endoscopy.

Diagnostic imaging

(click image to enlarge)

otoscopic image
audiogram
CT (axial view)
OCT (3D view)
case2-coronal
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case2-sagittal
click to sagittal view
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case 1 axial CT/OCT fused

Clinical findings

In the CT, OCT and fused coronal images, it can be seen that the umbo (U) had detached from the TM and the malleus (M) had shifted medially by approximately 1.5mm. The umbo of the malleus, which would be contiguous with the TM in a normal ear, can be seen lying inferior to the incudostapedial joint (ISJ) in the coronal cut and can be followed superiorly. The umbo can also be seen in the axial image.In the OCT image, but not in the CT image, a fibrous connection (FC) is visible between the medialized neck of the malleus (MN) and the incus (I). Both the CT and OCT also show a thickening of the mucosa (MTh) around the round window niche (RWN) and on the cochlear promontory (CP), presumably due to scarring associated with reactive inflammatory changes from persistent exposure of the mucosa to air immediately following the injury.