Traumatic dislocation of middle ear ossicles: A new computed tomography classification predicting hearing outcome.

Mantokoudis, Georgios; Schläpfer, Njima; Kellinghaus, Manuel; Hakim, Arsany; Von Werdt, Moritz; Caversaccio, Marco D.; Wagner, Franca (2021). Traumatic dislocation of middle ear ossicles: A new computed tomography classification predicting hearing outcome. PLoS ONE, 16(2), e0245796. Public Library of Science 10.1371/journal.pone.0245796

journal.pone.0245796.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (1MB) | Preview


To assess the feasibility of radiologic measurements and find out whether hearing outcome could be predicted based on computer tomography (CT) scan evaluation in patients with temporal bone fractures and suspected ossicular joint dislocation.


We assessed 4002 temporal bone CT scans and identified 34 patients with reported ossicular joint dislocation due to trauma. We excluded those with no proven traumatic ossicular dislocation in CT scan and patients with bilateral temporal bone fractures. We measured four parameters such as malleus-incus axis distance, malleus-incus angle at midpoints, malleus- incus axis angle and ossicular joint space. The contralateral healthy side served as its own control. Hearing outcome 1-3 months after the index visit was analyzed. We assessed diagnostic accuracy and performed a logistic regression using radiologic measurement parameters for outcome prediction of conductive hearing loss (defined as >20dB air-bone gap).


We found excellent inter-rater agreement on the measurement of axis deviation between incus and malleus in CT scans (interclass correlation coefficient 0.81). The larger the deviation of incus and malleus axis, the higher probability of poor hearing outcome (odds ratio (OR) 2.67 per 0.1mm, p = .006). A cut-off value for the axis deviation of 0.25mm showed a sensitivity of 0.778 and a specificity of 0.94 (p < .001) for discrimination between poor and good hearing outcome in terms of conductive hearing loss.


Adequate assessment of high resolution CT scans of temporal bone in which ossicular chain dislocation had occurred after trauma was feasible. Axis deviations of the incus and the malleus were strongly predictive for poor hearing outcome in terms of air conduction 1-3 months after trauma. We propose a 3-level classification system for hearing outcome prediction based on radiologic measures.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Mantokoudis, Georgios, Kellinghaus, Manuel, Hakim, Arsany, Von Werdt, Moritz, Caversaccio, Marco, Wagner, Franca


600 Technology > 610 Medicine & health




Public Library of Science




Martin Zbinden

Date Deposited:

24 Feb 2021 15:20

Last Modified:

05 Dec 2022 15:48

Publisher DOI:


Related URLs:

PubMed ID:





Actions (login required)

Edit item Edit item
Provide Feedback