Unusual Middle Ear Mischief

This morning I’ve seen an interesting case of a chap with middle-ear trauma. He had a perforated eardrum in December last year and came for a follow-up today. He was somewhat reluctant to tell me what happened (understandably, if it was self-inflicted!) Apparently he was cleaning his left ear with an ear bud when his telephone rung. Oooooops….. He says the person on the other end quite possibly ended up with noise trauma!

Interestingly enough, his audiogram in December indicated a mixed hearing loss and today, with the perforation closed up, the audio indicates a significant sensory-neural dip at 2kHz (down to 50dB!). The conductive component has disappeared altogether. I had a chat with the ENT consultant who says this is quite interesting and is sending the patient for a MRI scan. He wondered if the guy hasn’t had a loss prior to the trauma. In the absence of other symptoms, the ENT doesn’t feel the need to explore the middle ear as such, but the sensory-neural component certainly is interesting (and could benefit from a hearing aid!).

This is just reiterating the golden rule: “nothing smaller that your elbow in your ears please!”

Dezi Belle

P.s. I’ve managed to locate an interesting article of two similar case studies:

Penetrating middle ear trauma: a report of 2 cases


Penetrating middle ear injury can result in heaving loss, vertigo, and facial nerve injury. We describe the cases of 2 children with penetrating trauma to the right ear that resulted in ossicular chain disruption; one injury was caused by cotton-tipped swabs and the other by a wooden matchstick. Symptoms in both children included hearing loss and otalgia, in addition, one child experienced ataxia and the other vertigo. Physical examination in both cases revealed a perforation in the posterosuperior quadrant of the tympanic membrane and visible ossicles. Audiometry identified a moderate conductive hearing loss in one child and a mild sensorineural hearing loss in the other. Both children underwent middle ear exploration and reduction of a subluxed stapes. We discuss the diagnosis, causes, and management of penetrating middle ear trauma. To reduce the morbidity, associated with these traumas, otologic surgeons should act promptly and be versatile in choosing methods of repairing ossicular chain injuries.

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One Response to “Unusual Middle Ear Mischief”

  1. Steve says:

    Did the audiogram show an overt Carhart Notching type morphology I wonder? Hmmm.

    Looking at that scarring/ ?sclerosing, thinking big trans-tympanic resonance dip > therefore be aware this could be an audiometric-artefactual snhl?

    Speech test result may have helped disambiguate?

    (Over-driven Cochlea usually more circa 4kHz dip. Wonder if subsequent MRI result showed much ossicular involvement too?)

    Aided gain preferences/ functionals at any subsequent hearing instrument fitting could be the ultimate give-away though, but, good luck with decent feedback-suppression on your open-fit!
    Hope the chap not too troubled by tinnitus.
    Thanks Dezi for bringing up another typical real-life interesting case from your diary!
    Regards, Steve.

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