1503 - Unexpected Silence: Navigating Bilateral Ossicular Chain Disruption After Trauma

Case Diagnosis: Conduction Hearing Loss Secondary to Ossicular Chain Dislocation

Case Description: A 28-year-old male presented to the emergency department following a pedestrian versus truck collision. Head imaging demonstrated multifocal hemorrhagic contusions, subdural hematomas, and a right parietal calvarial fracture. Additional imaging revealed bilateral temporal and parietal bone fractures and ossicular chain dislocations (OCD). Otolaryngology was consulted and recommended observational management. His hospitalization and rehabilitation course were complicated by severe hearing loss, requiring him to lip-read and write for all communication. Unfortunately, nine months post-injury, minimal hearing had returned in his left ear, and he continued to have complete hearing loss in the right ear.

Discussions: Hearing loss secondary to traumatic brain injury (TBI) is a well-documented clinical phenomenon. A rare cause of conductive hearing loss (CHL) following TBI is OCD. Typically, OCD is precipitated by trauma to the temporal bones, with the vast majority of patients spontaneously recovering hearing within six months. This case is unique for two reasons: he had bilateral ossicular chain dislocations causing profound hearing loss, and his hearing loss had not resolved several months post-injury as anticipated. Though the typical treatment of OCD is conservative management, bilateral ossicular chain dislocations, and spontaneous recovery are particularly rare and likely warrant referral for definitive treatments, such as ossiculoplasty, upon early detection.

Conclusions: This case highlights important points for physiatrists. Post-TBI hearing loss can often be challenging to detect as concomitant encephalopathy and aphasia are common in this patient population. Following temporal bone fractures, a focused audiometry evaluation with particular attention to the OCD on scan should be warranted. More importantly, while decisions concerning ossicular reconstruction for CHL are often postponed, patients with bilateral ossicular chain dislocations may benefit from earlier intervention, given the associated profound hearing loss and limited evidence of spontaneous recovery. Earlier definitive treatment would positively impact their ongoing rehabilitation course.