Traumatic stapes luxation requiring removal of the stapes and ossicular reconstruction using Apacerum-C

Abstract

Traumatic stapes luxation into the vestibule with perilymph fistula due to a cotton swab injury is relatively rare. A 36-year-old female with severe vertigo and aural fullness in the left ear after using a cotton swab was transported to our hospital by an ambulance. On physical examination, perforation of the posterior tympanic membrane was confirmed. The stapes was luxated into the oval window when observed through the site of the perforation. An audiogram revealed a moderate degree of mixed hearing loss in the left ear. Spontaneous rightward nystagmus was observed, and the result of a fistula test conducted with a Politzer bulb was positive. Temporal bone computed tomography revealed that the stapes was luxated into the oval window. She was diagnosed with traumatic luxation of the stapes into the oval window, and perilymph fistula in the left ear. To control the severe vertigo and reconstruct the ossicular chain, left tympanoplasty was performed under general anesthesia. The patient was informed of the possibility of postoperative deafness if perilymphatic gusher occurred before the surgery. She consented to undergo the procedure, and the operation was performed on the same day. The stapes was luxated into the oval window with detached stapedial tendon, and perilymph flowed out of the oval window. The luxated stapes was carefully removed, assisted by an ear endoscope. Perilymphatic gusher did not occur. The fascia of the temporalis muscle was placed on the oval window, and ossicular reconstruction was performed by inserting Apacerum-C between the fascia and long process of the incus. Immediately after surgery, vertigo improved and nystagmus disappeared. The patient was able to walk with mild dizziness on postoperative day 1, and she was discharged on postoperative day 2. Hearing function gradually improved, and floating dizziness disappeared on postoperative day 7. Taste disorder was not observed. In this case, we achieved good results for both hearing and vestibular symptoms after surgery. However, in past literatures, the hearing outcomes of the cases that require stapes removal are sometimes unsatisfactory after surgery. We believe that providing adequate preoperative explanation on the possibility of poor hearing improvement is important.