Ossicular Discontinuity

Ossicular Discontinuity

Hearing Loss

Etiology

Audiogram

Exogeneous

meaning: produced or originating outside the organism

(outside the genes).

Potential Causes:

Trauma Degenerative disease Infectious process

Remember:

Conductive HL

=

Air bone gaps

AC in HL range

BC in normal

hearing range

Type:

• Conductive Hearing Loss
• Variety of conductive hearing losses can be found, and depend on location and extent of disarticulation

Degree:

• Moderate Hearing Loss
• Interestingly, the largest hearing loss

is present when TM is intact

• This is called "Maximum Conductive HL" and can reach up to 50-60dB
• Perforated eardrum experiences

lesser degrees of HL

Tympanic

membrane

perforation

Barotrauma

Congenital ear

malformation

Temporal bone

fracture

Audiograms of patients with Ossicular Discontinuity show all

expected findings consistent with Conductive HL

Chronic ear infections

such as Ottitus Media

Destructive tumors

such as

Cholesteatoma

In this case:

• Patient suffers from both Cholesteatoma & Otitius Media
• Often occur simultaneously

What is Ossicular Discontinuity?

Symptoms

Treatment

Ossicular Chain Reconstruction & Replacement

• Sudden conductive hearing loss
• haemotympanum and otorrhoea

Other Associated Problems

Diagnosis

Treatment depends on the severity of the hearing loss. Factors include:

• a conductive hearing loss of more than 30 dB longer than 6 months post injury

• Hearing screening/evaluation
• Endoscopy
• CT Scan
• to determine the extent of the disease
• to guide surgery

• Ossicular discontinuity is typically an abnormal separation of the middle ear bones.
• This can be caused by middle ear infections injury, or malformation of the ossicles
• Ossicular Discontinuity can lead to conductive hearing loss due to sound not being transmitted properly

• Surgical
• acute or delayed
• relocation or reconstruction with a prosthese or cartilage allografts
• Conservative
• hearing aids

• Hearing loss
• Chronic ear infections
• Otitis Media
• Cholesteatoma - a benign tumor that is caused by the build up of skin cells and protein behind the eardrum
• Congenital ear malformation
• Tinnitus

Pathology

Prevalence and Risk Factors

• Traumatic
• separation of the joint connecting the incus to the stapes
• separation of the joint connecting the malleus to the incus
• Fracture of the arch stapes
• blast injuries
• Atraumatic
• congenital ear malformation
• erosive disease
• cholesteatoma
• chronic otitis media

• 82% of patients who suffer from chronic otitis with chloestatoma will suffer from ossicular discontinuity as well
• Ossicular discontinuity is reported less often with patients who have chronic otitis without chloestatoma
• 78% of patients had lesions on the incus
• 45% of patients had lesions on more than one ossicle