Embedded incus into the external auditory canal following temporal bone fracture

Temporal bone fractures are commonly classified as either otic capsule-violating or otic capsule-sparing. These injuries may be associated with several otologic complications, including conductive hearing loss, sensorineural hearing loss, facial nerve injury, tympanic membrane perforation, hemotympanum and ossicular chain disruption. Conductive hearing loss is a particularly important sequela, as it may persist despite apparent clinical recovery following head trauma and can indicate underlying ossicular chain injury. This report details a case of a middle childhood boy that produced persistent conductive hearing loss as a result of a longitudinal temporal bone fracture that spared the otic capsule. The complete otologic examination showed a small posterior tympanic membrane perforation and a swelling in the posterior external auditory canal wall. High-resolution CT revealed that the incus was embedded in the posterior wall of the external auditory canal. Tympano-ossiculoplasty using a tragal cartilage graft and a partial ossicular replacement prosthesis (PORP) reduced the air-bone gap from 45 dB to 15 dB. This case emphasizes that a persistent conductive hearing loss in a child after a temporal bone fracture should prompt a long-term follow-up and an evaluation for less commonly occurring ossicular injury that may require surgery.