Stapes Crural Fracture without Perilymph Fistula by Q-Tip Injury

We report a rare case where Q-tip induced mixed hearing loss without perilymph fistula and demonstrate the need for computed tomography imaging with three-dimensional reconstruction where fracture and dislocation of the stapes are suspected. A 28-year-old male experienced an accidental penetrating injury by a Q-tip in the right ear 6 years previously. Temporal bone computed tomography revealed a dislocation of the stapes and incus. A volume-rendered three-dimensional reconstruction revealed that the stapes was rotated 180° laterally toward the handle of the malleus. Exploratory tympanotomy revealed dislocation of the incus and superstructure of the stapes, with an intact tympanic membrane. The patient’s hearing was successfully improved by ossiculoplasty (malleus-footplate assembly) using autologous incus. To differentiate stapes fracture with dislocation as the cause of traumatic conductive hearing loss, three-dimensional reconstruction of the temporal bone computed tomography is helpful before exploratory tympanotomy.