Innovative Categorization and Operative Management of Auditory Ossicle Disruption Following Trauma: Therapeutic Efficacy and Interventional Paradigms.

Abstract

Currently, there is no consensus on the treatment protocol for ossicular chain trauma. This study aims to investigate the classification and treatment strategies for traumatic ossicular chain dislocation. We retrospectively analyzed 15 patients. Traumatic ossicular chain dislocations were categorized based on the location of trauma identified during surgery: Type I-ossicular trauma without stapediovestibular dislocation; Type II-stapediovestibular dislocation (with or without associated incus dislocation). Of the 10 patients with Type I trauma, 9 experienced head trauma, and 1 had a penetrating injury to the external auditory canal. Among these, 2 cases involved incudomalleolar dislocation, 2 cases incus dislocation, 5 cases incudostapedial dislocation, and 1 case a fracture of the anterior and posterior arches of the stapes. Seven patients exhibited conductive hearing loss, while 3 presented with mixed hearing loss. Ossiculoplasty was performed using partial ossicular replacement prostheses (PORP) in 8 patients and total ossicular replacement prostheses (TORP) in 2 patients. Postoperative air conduction thresholds significantly improved in all 10 patients. In Type II trauma, all 5 patients had a penetrating injury to the external auditory canal, resulting in varying degrees of hearing loss. Postoperatively, 3 patients experienced improvement in hearing, while 2 showed no significant change. All patients developed vertigo and tinnitus following the trauma, with vertigo resolving after surgery. Pneumolabyrinth was detected in 2 patients. We propose a novel classification system for traumatic ossicular chain dislocation. Treatment strategies should be tailored according to the specific trauma type.