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.