Presentation
Acute conductive hearing loss on the left following head trauma.
Patient Data
On the left, there is a fracture in the orientation parallel to the long axis of the temporal bone. There is incudomalleolar joint malalignment, and also incudostapedial joint malalignment.
The right side is normal.
Normal and abnormal incudomalleolar joint alignment.
These spot images from this case illustrate the normal ice cream and cone relationship of incus and malleolus on the right, and the abnormal alignment on the left.
Ice cream cone image (strawberry flavor)
Authour: Unconfirmed.
Source URL: https://commons.wikimedia.org/wiki/File:StrawberryIce.jpg
Licence: Public domain.
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Case Discussion
Longitudinal temporal bone fractures are more common than the transverse type. Conductive hearing loss can be due to middle ear hemorrhage or, as in this case, due to ossicular chain disruption. In any case of temporal bone fracture, ossicular joint alignments should be assessed. The ice cream cone sign helps determine whether the incudomalleolar articulation is normal.
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