Objectives: To evaluate the natural history of traumatic conductive hearing loss.
Study design: Retrospective chart review.
Methods: Otologic and audiometric evaluations of patients in the early posttraumatic phase were compared with evaluations at follow-up. Assessment included etiologies of trauma, classification of hearing loss, factors causing conductive loss, and analyses of changes in air-bone gaps, pure-tone averages and hearing loss class.
Results: There were 45 patients, representing 47 ears, with sufficient initial and follow-up documentation to analyze the natural history of traumatic conductive hearing loss. Overall, 77% of ears showed an improvement in pure-tone averages without surgical intervention. Air-bone gaps closed from an average of 24.8 +/- 12.1 to 13.2 +/- 11.1 dB. Only 11% of ears demonstrated a decrease in pure-tone averages, and 12% showed no change in thresholds. All forms of injury contributing to the conductive hearing loss had good outcomes. Specifically, tympanic membrane perforations showed final air-bone gaps of 14.9 +/- 11.2 dB; cases of hemotympanum had final air-bone gaps of 10.0 +/- 8.1 dB; and suspected ossicular chain disruptions had final air-bone gaps of 13.9 +/- 12.3 dB. Only 5 of 47 ears ultimately required surgical intervention for persistent pathology.
Conclusion: Patients with all forms of traumatic conductive hearing loss can be initially managed conservatively. Even suspected ossicular chain disruptions have a high rate of spontaneous reparation. Surgical intervention for perforation or conductive hearing loss should be undertaken in the rare cases when these conditions persist greater than 6 months.