Isolated Malleus-handle Fracture

Objectives: To report a series of 8 isolated malleus-handle fractures

Materials and methods: We retrospectively collected patients’ characteristics, main symptoms, circumstances of onset, audiometric evaluations, imaging findings, therapeutic strategy, surgical features if any and outcomes.

Results: All patients reported the same history of brisk withdrawing of a finger from the external auditory canal, leading to a sudden hearing loss and aural fullness. Meticulous otomicroscopy revealed the broken malleus with excessive movement of the distal part of the malleus at Valsalva maneuver. Imaging confirmed the fracture and displacement of the malleus. Hearing tests showed a mild to moderate mixed hearing loss with high compliance at tympanometry. Two patients declined surgical management. A transcanal exploratory tympanotomy was performed in 6 cases. The fracture was located below the lateral process of the malleus. Rehabilitation was performed with either incus interposition, cartilage stabilization of the fractured-site or reconstruction with bone cement. Postoperatively, hearing loss and aural fullness improved in all patients.

Conclusion: Malleus handle fracture should be systematically suspected in case of hearing loss and aural fullness of sudden onset after digital manipulation of the external auditory canal. Several surgical procedures can be applied but use of bone cement seems to be the most promising.