title: Treatment of traumatic stapediovestibular luxation: case report with the introduction of a new technique and review of literature.
abstract: OBJECTIVE
  Stapediovestibular luxations are rare lesions that are most commonly caused by direct, penetrating trauma to the external ear canal. In this type of ossicular dislocation, disruption of the annular ligament or footplate fracture may lead to a perilymphatic fistula (PLF) presenting with cochleovestibular symptoms including (progressive) sensorineural hearing loss, tinnitus, and vestibular symptoms. The objective of this article is to define the optimal treatment of stapediovestibular luxations and review the literature on this topic.
  
  
  METHODS
  We present a case of internal stapediovestibular dislocation and pneumolabyrinth after penetrating trauma with predominantly conductive hearing loss and incapacitating vertigo.
  
  
  METHODS
  Middle ear inspection with removal of the luxated incus, repositioning of the stapes with a "stapedial strut" and closure of the tympanic membrane.
  
  
  METHODS
  Hearing outcome and vestibular symptoms of this patient are presented, and all comparable cases in the literature are reviewed.
  
  
  RESULTS
  Complete resolution of the vestibular symptoms and stabilization of the bone conduction thresholds.
  
  
  CONCLUSIONS
  In patients with pneumolabyrinth after middle ear trauma with mild symptoms, we recommend initial conservative treatment with close monitoring of hearing. In patients with severe, persisting, or progressive vestibulocochlear symptoms, exploratory tympanotomy should be performed to check for and treat PLF. Oval window fistula repair is reported to have variable hearing outcomes but offers complete resolution of vestibular symptoms in most cases. The stapedial strut is one of the possible surgical techniques in case of an internally luxated stapes.
authors.affiliation: European Institute for Otorhinolaryngology, Wilrijk, Antwerp, Belgium.
authors.forename: Marie
authors.initials: M
authors.lastname: Bogaerts
authors.forename: Jérôme
authors.initials: J
authors.lastname: Waterval
authors.forename: Joost
authors.initials: J
authors.lastname: van Dinther
authors.forename: Thomas
authors.initials: T
authors.lastname: Somers
authors.forename: Andrzej
authors.initials: A
authors.lastname: Zarowski
authors.forename: Frans Erwin
authors.initials: FE
authors.lastname: Offeciers
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D001844:Bone Conduction; D054893:Cone-Beam Computed Tomography; D007758:Ear, Inner / Q000293:injuries; D004432:Ear, Middle / Q000473:pathology; D005260:Female; D020197:Head Injuries, Penetrating / Q000150:complications / Q000628:therapy; D006314:Hearing Loss, Conductive / Q000209:etiology / Q000628:therapy; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy*; D013506:Otologic Surgical Procedures / Q000379:methods*; D013199:Stapes / Q000293:injuries*; D013201:Stapes Surgery / Q000379:methods*; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology / Q000601:surgery; D014717:Vertigo / Q000209:etiology / Q000628:therapy; D014722:Vestibule, Labyrinth / Q000293:injuries* / Q000601:surgery
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents