Audiological Considerations in the Hearing Assessment of a Patient with Anterior Crus Fracture of the Stapes: A Case Report

Introduction: Isolated fracture of the anterior crus of the stapes is a rare etiology of post-traumatic conductive hearing loss, which may lead to delayed diagnosis due to unremarkable otoscopic findings. In such scenarios, the integration of a meticulous clinical history, comprehensive audiological evaluation, and high-resolution computed tomography (HRCT) is decisive in identifying the lesion.
Case Report: A 35-year-old male presented with right unilateral hearing loss, aural fullness, and mild tinnitus following direct trauma to the right temporal region in a motor vehicle accident. Audiological assessment revealed conductive hearing loss in the right ear with an air-bone gap of approximately 30–35 dB, a Type A tympanogram, and absent acoustic reflexes. HRCT of the temporal bone demonstrated an isolated fracture of the anterior crus of the stapes, without evidence of incudostapedial joint dislocation or labyrinthine fistula. The patient underwent transcanal stapedotomy with the placement of a piston prosthesis. At the six-week follow-up, air-conduction thresholds had improved to approximately 15-20 dB.
Conclusion: This case underscores that in patients with post-traumatic conductive hearing loss, the presence of normal tympanometry coupled with absent acoustic reflexes should prompt the consideration of subtle ossicular chain injuries, particularly those involving the stapes. Furthermore, a precise audiological assessment plays a pivotal role in guiding surgical decision-making, documenting therapeutic outcomes, and planning postoperative rehabilitation.