FRCS (ORL-HNS) · SECTION 1 SBA

Ossicular discontinuity

After a temporal-bone injury, a patient has persistent 35-dB conductive hearing loss, normal bone thresholds and an intact healed tympanic membrane. Tympanometry is hypercompliant. What is the most likely explanation?

CHOOSE ONE ANSWER

Best of five

  1. A. Ossicular-chain discontinuity
  2. B. Cochlear concussion
  3. C. Vestibular schwannoma
  4. D. Presbycusis
  5. E. Endolymphatic hydrops
ANSWER AND REASONING

A. Ossicular-chain discontinuity

Persistent large conductive loss with an intact drum and excessive compliance after trauma is characteristic of ossicular disruption, commonly involving the incudostapedial joint.

Why every option is right or wrong

A. Ossicular-chain discontinuity: Persistent large conductive loss with an intact drum and excessive compliance after trauma is characteristic of ossicular disruption, commonly involving the incudostapedial joint.

B. Cochlear concussion: This produces sensorineural rather than purely conductive loss.

C. Vestibular schwannoma: A retrocochlear lesion does not create hypercompliant tympanometry.

D. Presbycusis: Age-related loss is sensorineural and bilateral.

E. Endolymphatic hydrops: Ménière disease produces fluctuating sensorineural loss and vertigo.

What if the scenario changed?

If the tympanogram were flat with a visible effusion, middle-ear fluid would be a more likely cause of conductive loss.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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