FRACTURE OF MALLEUS AND DISLOCATION OF MULTIPLE OSSICULAR JOINTS AFTER WELDING FLAME BURN - A CASE REPORT

Australian Journal of Oto-Laryngology, Jun 2004 by Liu, Wei, Zheng, Yiqing, Ou, Yonkang, Xu, Yaodong, Et al

Inner ear damage is not uncommonly seen in association with direct middle ear injury[5,6,7,8,9,10]. With such injury one would expect the patient to experience disequilibrium and sensori-neural or mixed hearing loss. Trauma to the ossicular chain is likely to cause some inner ear damage. Such damage has been seen in the current case. As there was no charred material in the middle ear we assume that the inner ear trauma was induced by the direct instrumentation rather than the welding spatter.

HRCT is the method of choice for evaluation of ossicular trauma [11,4]. Meriot et al. has recommended different CT strategies in order to identify ossicular dislocation and fracture on axial imaging [4]. Otoendoscopy in this case proved to be an efficient method of examination for assessing the degree of middle ear trauma particularly at the second examination. Otomicroscopy would be equally useful.

A perilymph fistula will frequently accompany injuries to the stapes such as subluxation or fracture. In this current case no perilymph leak was identified and the patient did not experience disequilibrium. Further assessment of the stapedial status will be made at the time of tympanoplastic surgery.

In the current case welding goggles were used to protect the eyes and the front of the head and neck. The position of the welders head, however, allowed direct intrusion of the welding spatter into the ear. We have recommended better protection of the ears for welders.

In this case who had widespread inflammation in both ear canal and middle ear, we used Cefzil for prevention of infection. This is always recommended in traumatic perforations if hygienic situation of the ear could be problematic. We never use eardrops if no infectious secretion can be seen in the middle ear or around the perforation. Vitamin B family medication is prescribed whenever sensorineural hearing loss exists, such as in our case, to promote the recovery of this component of hearing loss.

Normally we would perform tympanoplastic surgery for middle ear trauma only when the patient has a totally "dry and clean" middle ear. And we would repair the ear drum and ossicular chain in one stage if possible. The operation can be undertaken under local or general anesthesia.

Acknowledgement

The authors thank Dr. Vincent Cousins, a principle specialist from Melbourne of Australia, for his excellent ideas in terms of the writing of the manuscript.

Reference

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3. Wang L.F., Ho K.Y., Tai CF., Kuo W.R. Traumatic ossicular chain discontinuity-report of two cases. Kaohsiung J Med Sci 1999; 15; 504-9

4. Meriot P, Veillon F, Garcia JF, Noncnl M, Jezequcl J, Bourjat P, Bellet M. CT appearances of ossicular injuries. Radiographies 1997; 17; 1445-54