Otology Japan
Online ISSN : 1884-1457
Print ISSN : 0917-2025
ISSN-L : 0917-2025
Original Article
Management of traumatic stapes dislocation with perilymphatic fistula and subsequent improved hearing with the use of a malleus attachment piston: a case report
Takaki OgawaSaki KawadeHisaki AsaiHiromi Ueda
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2023 Volume 33 Issue 3 Pages 191-196


In the case of a traumatic perilymphatic fistula, the patient profile, the type of surgery to be performed, and the timing of surgery should be considered. Herein, we report a case of a traumatic perilymphatic fistula in which the left ear was injured by a cotton swab, resulting in hearing loss and dizziness, which improved after stapes surgery. Upon initial examination, the patient had a perforated left tympanic membrane and spontaneous nystagmus. A computed tomography scan revealed a dislocation of the incudomalleal joint and emphysema in the vestibule. As the patient had conductive hearing loss but no elevated bone-conduction threshold, the initial treatment included the administration of antibiotics and corticosteroids. Concurrently the patient was put on bed rest. On the 8th day since the incident, the dizziness resolved. However, an elevation of the bone-conduction threshold developed. Hence, the surgery was performed. The incus was removed, followed by the stapes because the entire footplate had been dislocated. The air trapped in the emphysematous vestibule was replaced with saline. The oval window was covered with subcutaneous connective tissue, a malleus attachment piston was placed on it, and the tympanic membrane perforation was closed underlay. Postoperatively, the hearing improved, and the dizziness and nystagmus disappeared. Traumatic perilymphatic fistulas require appropriate decision-making regarding the timing and surgical technique.

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© 2023 Japan Otological Society
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