Bilateral incudomalleolar dislocations: an unusual cause of deafness.

To cite: Paddock M, Hodgson T, Bhattacharyya D. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-218733 DESCRIPTION A 57-year-old woman was seen in an outpatient neurosurgery clinic after reporting daily headaches, a ‘whooshing and squelching’ sound in her head and reduced hearing in her left ear. Three months’ prior she required admission following serious head trauma. Imaging at that time revealed multiple skull fractures with extra-axial haemorrhages. Follow-up thin section CT of the petrous temporal bones (figure 1) demonstrated bilateral incudomalleolar dislocations. Ossicular chain disruption can be easily overlooked and thorough assessment of the middle ear should be performed on follow-up imaging, particularly considering persistent patient symptoms. At initial follow-up, the patient reported persistent headaches, tinnitus and bilateral decreased hearing loss, worse on the left. Formal audiological testing revealed a left-sided deficit which was corrected with a hearing aid. Further follow-up revealed no change in hearing and resolution of her headaches.