Discussion
We present an unusual case of displaced stapes in the vestibule, which
induced vertigo and significant hearing loss. Several papers reported
vertigo related to the damage to the stapediovestibular junction [2,
3]. Traumatic injury on the ossicular chain or prosthesis displaced
into the vestibule manifests as positional vertigo and hearing loss
[4-6]. Our reported case may be due to the problematic length of the
reconstructed ossicular chain. In this case, the repaired tympanic
membrane pressed the overlong chain, creating stapediovestibular
luxation and stapes dislocation.
The free-flowed stapes in the vestibule cavity explained paroxysmal
vertigo. Inertial stapes are relative to fast flow endolymph when the
patient shakes her head, which causes benign paroxysmal positional
vertigo (BPPV)-like symptoms. According to our OCR and SVV results, the
function of vestibular organs was compensated after the initial trauma,
which allowed the patient to practice normally in daily life. In
addition, the stapes that caused slight fibrosis after two years may
contribute to minimal mesenchymal tissue within the inner ear to develop
adhesion. Thus, earlier identification and timely action are the keys to
saving patients from persistent vertigo and irreversible hearing loss if
any similar complication happens.
In recent years, endoscopic ear surgery is gaining popularity and
expanding the indications in otological fields [1]. As an invaluable
tool, the endoscope is a good starting point for junior doctors.
However, with a long learning curve, this less invasive operation has
certain pitfalls. First, due to the bi-dimensional view, inexperienced
doctors lose depth perception, which may be attributed to the wrong
length of the reconstructed ossicular. Besides, the operation of scope
and instruments with single-hand may rub the narrow canal, which causes
further stenosis. In this case, surgeons need more practice and gentle
manipulation during the endoscopic surgery to prevent complications.