Eyespy

A 37 year old man was jogging while listening to his digital music player. Lightning struck a nearby tree, and he was thrown 2.4 m and sustained second degree burns to his chest and left leg. He had two linear burns that matched the positions of the wires to his earphones, along his chest and neck, up both sides of his face, and in the external auditory meati. His tympanic membranes were perforated by pressure waves from the rapid heating and expansion of air around the current. The lightning current was directed by the sweaty metal earphones and led to severe conductive hearing loss. Bilateral dislocation of the incudomalleolar joints was seen by computed tomography. He also had a mandibular fracture, probably caused by muscle contraction rather than trauma (New England Journal of Medicine 2007;357:198-9 doi: 10.1056/NEJMc070260).

Normal: “Ice cream cone” appearance, where the head of the malleus (arrow) articulates with the body of the incus (arrowhead) as expected

Case: Transverse image of the middle ear showing dislocation of the incudomalleolar joint