Conductive Hearing Loss

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Conductive hearing loss can result from injury to the middle ear with or without temporal bone fracture. Often the injury causes bleeding from the external auditory canal skin. If CSF otorrhea also is present, the clot should be left alone to form a natural biologic dressing as the CSF leak usually stops spontaneously (see below). If no leak is present, under appropriate magnification blood can be gently cleaned in an attempt to delineate if the source of bleeding is the external or middle ear. Debris,

External Honing

Hone over 1ac

FIGURE 18-3 Translabyrinthine approach to the facial nerve. IAC, internal auditory canal.

Hone over 1ac

FIGURE 18-3 Translabyrinthine approach to the facial nerve. IAC, internal auditory canal.

Blood Clot Ear Canal
FIGURE 18-4 Skin incision and anatomic relationships in obtaining a graft of the greater auricular nerve.

cerumen, keratin, and hair should be removed. The membrane may be perforated, or it may be intact with blood accumulation in the middle ear (hemo-tympanum). Within the middle ear, ossicular discontinuity or fracture occurs in 30% of patients with tympanic membrane lacerations. Even if the tympanic membrane is torn, the majority of tympanic membrane perforations will heal spontaneously, most within 6 weeks and nearly all the rest within 12 weeks. If hemotympanum is noted on examination, it is left to resolve spontaneously over 4 to 6 weeks. Alternatively, hemotympanum can be evacuated after myringotomy, although some authors have noted a potential risk of infection. patients should undergo serial audiometric assessment to follow recovery of the conductive hearing loss.

if a conductive hearing loss persists after hemo-tympanum resolves or after the drum heals, then ossicular discontinuity is suspected. Surgical exploration is recommended for a persistent conductive hearing loss of 25 dB or greater. A period of 3 to 4 months is advised prior to exploration to allow for a decrease in posttraumatic edema, as well as to allow for spontaneous recovery. patients should be informed that a hearing aid is a viable alternative to exploration and ossicular reconstruction.

Incudostapedial joint separation accounts for up to 82% of ossicular causes of a conductive hearing loss discovered at exploration.25,26 Other findings can include incudomallear disarticulation, incus dislocation, and fracture of the stapes crura or footplate. Fracture of the footplate mainly occurs secondary to transverse fractures passing through the oval window.27 A fracture of the footplate (with or without displacement of the fragments) may cause a perilymph fistula with pneumolabyrinth.28

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