1. Ossicular chain trauma(Ear trauma)
Trauma to the ear may result in fractures of the temporal bone & damage to the cochlea & facial
nerve. Lesser trauma results in damage to the ossicular chain.
1. The most common lesion identified is dislocation of the incus.
2. In some cases, there is disruption of the incudostapedial joint with minimal
displacement of the incus.
3. More severe trauma, there may be complete separation of the incus from malleus&
stapes.
4. Fratures of the long process of incus may be occurred.
5. Handle of malleus may be fractured.
Types of trauma
Injuries to the ossicular chain may result from;
1. Head injuries;
2. Direct trauma during surgery;
3. Lightening.
Quite often, the lesion is not diagnosed until long after the injury.
Audiometric finding
A)PTA:
1. Incus dislocation is associated with a significant conductive hearing impairment.
2. High frequency sensorineural hearing loss due to trauma to the cochlea at the time of
injury.
B)Tympanometry can show a type A graph with a very high peak but this can be also occur in
normal ears.
Surgical management
1. In case of incus dislocation, reposition of incus in it’s positon using a posterior attic approach
combined with a tympanotomy. The incudomalleolar joint is relatively easy to re-establish
because the articular surfaces are complementary. The incudostapedial joint, with its small
area of contact, is more of a challenge.
a) A incudostapedial joint splint, made by modifying a silicone grommet, can be used
to stabilize the joint during healing.

2. b)The use of n-butylcyanoacrylate tissue adhesive has also been used for this
purpose.
2. Fractures of the stapes arch can be managed by the use of a strut or piston between the
incus & stapes.
3. Stapes luxation can be treated by stapedectomy.
4. Maleus handle fractures can be treated using small bone grafts.
Key points: a conductive hearing impairment that persist following head trauma is most likely due
to incus dislocation. Definitive diagnosis by exploratory tympanotomy. The result of reconstruction
surgery are generally better than those in COM.