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)
×
Download image
Term of use
How to atribute
For presentations / print
×
Share
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.