- Causation (medical evidence) (standard of proof)
- Consequences of injury (iatrogenic illness) (treatment) (surgery)
- Significant contribution (of compensable accident to development of condition)
- Fracture (ear)
The worker appealed a Board decision, which concluded that she was not entitled to benefits for the right ear surgery that replaced her stapes bone with a titanium prosthesis. The issue to be decided in this appeal was whether or not the worker's workplace accident significantly contributed to the worker's need for the surgical repair.
The appeal was allowed.A bar struck the worker in the face and caused her to fall to the ground. She recalled having a momentary loss of consciousness. Not long after the accident, the worker noticed her hearing had changed from her baseline pre-existing hearing loss. The worker's new post-injury symptoms included ringing and pulsating sounds in her ear (tinnitus). She experienced headaches, intolerance to noise and light, and balance issues. It was indicated that her hearing aid was not helping the way it used to. The stapes bone is a tiny bone in the middle ear. The stapes bone serves an important role in hearing sounds by conveying vibrations. If the stapes bone is fractured or becomes fixated, it can impair hearing. The Medical Discussion Paper on Hearing Loss and Tinnitus notes that physical injury to the ear is usually caused by blunt trauma, such as can occur in a significant head injury. Most will have had at least transient unconsciousness, such as was seen in this situation. It was noted that a concussion can cause microfractures and fixation of a footplate. As fractures heal, they can cause hearing damage. In addition, hearing loss that is unilateral is due to trauma rather than congenital otosclerosis. The worker underwent a stapedectomy after the accident, which removed the stapes bone and inserted the titanium prosthesis. The surgery was successful and the worker returned to her pre-accident base level hearing loss, which has remained steady with no balance problems. The Panel found that the workplace accident was a significant contributing factor in causing the stapes fracture and the need for right ear surgery. The worker was therefore entitled to benefits for the stapes fracture and associated surgical repair.