Ossicular dislocation ̈chelchen | Acute hearing loss

Ossicular dislocation ̈chelchen

The three ossicles (hammer, anvil and stirrup) transmit sound from the eardrum to the inner ear. Like all other joints, they are connected via connective tissue and ligaments, which are very vulnerable to violent impact. Although the joints between the auditory ossicles cannot be injured directly, they can be injured by strong violent impacts on the skull.

Accidents, falls and boxing can interrupt the connection between the individual ossicles. This leads to dislocation (luxation) and acute hearing loss. A surgical therapy (tympanoplasty, see below) can lead to improvement.

Skull fracture (basal skull fracture)

If the fracture line runs directly through the middle ear (longitudinal pyramidal fracture) in a skull fracture, this can damage the auditory nerve (vestibulocochlear nerve). In addition, the blood coming out of the fracture can flow into the middle ear and impair the sound transmission of the ossicles (hematotympanum). Surgical therapy is unavoidable for severe fractures. The therapy is interdisciplinary, i.e. the specialist in ear, nose and throat medicine works together with the specialist in neurology, the neuroradiologist and a neurosurgeon.

Therapy

What causes acute sensorineural hearing loss and how is it treated? – Sudden deafness (acute hearing loss, angina pectoris of the inner ear, apoplectiform deafness)Sudden deafness is a sudden, usually unilateral hearing loss. – Ear noises (tinnitus) and a cotton wool-like feeling of pressure can also occur.

A cause is rarely found, but is usually explained by a local circulatory disorder in the inner ear. – Many underlying diseases (e.g. high blood pressure, heart failure = cardiac insufficiency) can cause sudden deafness and must be taken into account in the therapy. Today, infusion treatment is the most important therapy.

The so-called hydroxyethyl starch solution (HAES) improves the flow properties of the blood. This effect is further enhanced by the addition of blood circulation-promoting drugs. An underlying disease such as high blood pressure should definitely be treated and stress, nicotine (smoking) and excessive coffee consumption should be avoided.

• Noise exposureHigh noise levels, such as those generated in loud discotheques or by jet engines, can lead to acute hearing loss. Noise in the ear, dizziness and a feeling of pressure in the ear can accompany the hearing loss. A longer break in a quiet environment, wearing hearing protection and ear muffs can help in the future.
• Infections of the inner earViruses and bacteria can acutely infect the inner ear and contribute to hearing loss. These are usually transmitted infections from the meninges (meningitis) or shingles (zoster oticus). Mumps, scarlet fever, typhus and borreliosis can also spread to the inner ear.

Treatment is carried out on the one hand with high doses of antibiotics or virus statics and on the other hand with anti-inflammatory drugs (cortisone). – Drug poisoning (ototoxicosis)Some drugs have the undesirable side effect of causing damage to the inner ear, dizziness and tinnitus. The inner ear damage, however, depends on the amount of the respective medication and is rather rare when administered in a controlled manner.

These drugs include antibiotics of the aminoglycoside group (gentamicin), diuretics (furosemide, trade name: Lasix®) and some cytosstatics (drugs used to treat cancer). If damage to the inner ear is caused by medication, the medication must be discontinued, because damage is reversible, especially at the beginning. – Environmental toxins

• Skull fracture (skull base fracture)In the case of a skull fracture, the fracture line can run through the ear parts.

If the fracture line lies in the area of the inner ear (transverse pyramidal fracture), acute hearing loss, dizziness and possibly facial paralysis (facial paresis) may occur. The treatment depends on the extent of the fracture and is carried out by a team of doctors from ENT, neurology and radiology. – Skull injury (blunt head trauma, labyrinthine shock, commotio labyrinthi) Even if the violent impact is not directly on the ear, a destructive shock wave can be transmitted via the ossicles to the inner ear.

The symptoms are manifold and are accompanied by massive hearing loss, dizziness, feeling of pressure and tinnitus. Depending on the extent of the injury, conservative or surgical therapy is sought. – Tear of the oval and/or round windowThe middle ear (tympanic cavity with ossicles) is connected to the inner ear (cochlea and archways) by two thin membranes (membranes; round and oval window).

These membranes can be damaged by accident, noise, ear surgery, pressure and tumours. Typical symptoms are variable hearing, dizziness, tinnitus and ear pressure. – Menière’s disease; Menière’s disease This disease mainly affects middle-aged men.

Conspicuously, it often occurs in vegetatively unstable patients after psychological stress, changes in the weather, alcohol, caffeine and nicotine abuse or after banal infections. In the foreground a severe rotary vertigo occurs at intervals, which is additionally accompanied by ringing in the ears and a cotton wool-like feeling of pressure in the ear. During the seizure there is an acute inner ear hearing loss which can last for several hours.

The cause is still unclear, but it is suspected to be a disturbance in the fluids of the organ of equilibrium (endolymph/perilymph) and their salt concentrations (electrolytes). The therapy is carried out symptomatically with drugs against nausea such as dimenhydrinate (Vomex ®). Betahistine (Acqamen retard ®) is administered in a seizure-free interval.