Bilateral incudomalleolar dislocations: an unusual cause of deafness

Description

A 57-year-old woman was seen in an outpatient neurosurgery clinic after reporting daily headaches, a 'whooshing and squelching' sound in her head and reduced hearing in her left ear. Three months' prior she required admission following serious head trauma. Imaging at that time revealed multiple skull fractures with extra-axial haemorrhages. Follow-up thin section CT of the petrous temporal bones (figure 1) demonstrated bilateral incudomalleolar dislocations. Ossicular chain disruption can be easily overlooked and thorough assessment of the middle ear should be performed on follow-up imaging, particularly considering persistent patient symptoms.

Figure 1

Cropped images of the left and right inner ear ossicles from an axial thin section CT scan through the petrous temporal bones demonstrating bilateral incudomalleolar dislocations (only left side labelled). i, incus; m, malleus; Orange arrow head, incudomalleolar dislocation; Red arrow, fracture line through left mastoid bone.

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