Traumatic stapediovestibular luxation: two contrasting cases highlighting the importance of early treatment decision: A case report and literature review

Rationale: – Traumatic stapediovestibular luxation is a rare but potentially devastating condition that may cause severe vertigo and hearing loss. Optimal management remains controversial because surgical manipulation around the stapes carries the risk of additional inner ear damage, whereas some patients recover with conservative treatment alone. Patient concerns: – Two patients presented with vertigo and hearing impairment after accidental penetrating ear trauma caused by cotton swabs. Diagnoses: – High-resolution computed tomography demonstrated stapes footplate invagination into the vestibule in both cases. Interventions: – In Case 1, early surgical repositioning of the stapes was performed on the third day after injury because of complete footplate invagination accompanied by bone-conduction hearing loss and severe vertigo. In Case 2, conservative management was selected because bone-conduction thresholds were preserved and vestibular symptoms improved spontaneously. Outcomes: – In Case 1, postoperative recovery included rapid resolution of vertigo and improvement of bone-conduction thresholds, particularly at low frequencies. In Case 2, vestibular symptoms resolved without surgery, although a mild residual air-bone gap remained. Lessons: – Bone-conduction deterioration, degree of footplate displacement, severity of vertigo, and depth of invagination on high-resolution computed tomography appear to be key factors for treatment selection. Conservative management may be safely continued in selected cases with mild posterior partial luxation and stable bone-conduction, whereas early surgical decision-making is essential when surgery is indicated to optimize vestibular and auditory outcomes.