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35 year old female with trauma.

Abnormal to see both incus and malleus in same coronal slice

Incus usually lies posterior to malleus head.

Longitudinal fracture

Parallel to long axis of T-bone

Most common (70-86%)

Transverse fracture (20%)

Perpendicular to long axis of T-bone

“Oblique” or “mixed” fracture.

Temporal-parietal trauma

TM rupture, hemotympanum

Typically spares labyrinth

Sensorineural hearing loss unusual

Conductive hearing loss due to ossicular disruption (20%)

Incudostapedial joint disruption

Malleoincudal disruption

Facial nerve involvement (20%).

Frontal-occipital trauma

Often involves IAC or labyrinth

SNHL common

Facial canal involvement common

Up to 40%.

Most common skull base fracture

Associated CSF leaks (15%)

Majority resolve spontaneously within 7 days

Less than 10% incidence of meningitis

Facial nerve injury

Most resolve spontaneously

Ossicular reconstruction for CHL after patient recovers from acute injuries.