Bilateral Fracture of the Handle Malleus: A Case Report and Review of the Literature

Abstract

Malleus fracture is a rare condition. Usually, the handle of the malleus is involved, and we do not find reports in the literature of this condition in the bilateral presentation. It is present as sudden conductive hearing loss commonly after digital manipulation of the external auditory canal. The diagnosis is based principally on clinical examination by otomicroscopy and audiometry. Cone-beam computed tomography emerging as a powerful tool in the field of otolaryngology, especially for explorations of paranasal sinuses and temporal bone, due to imaging with a high resolution and few artifacts with lower dose radiation in comparison with multislice computed tomography.

Isolated Fracture of the Malleus: An Overlooked Cause of Conductive Hearing Loss?

“…The systematic review yielded 22 publications for inclusion which are outlined in Table I. [4][5][6][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] A total of 46 cases from 45 patients were identified, and only 10 of which were published before the 21st century. When combined with the current series, there are a total of 58 cases (Table II).…”

“…The systematic review yielded 22 publications for inclusion which are outlined in Table I 4–6,11–29 . A total of 46 cases from 45 patients were identified, and only 10 of which were published before the 21st century.…”

Forces Required for Isolated Malleus Shaft Fractures

“…Injury including the malleus is rare and occurs in only 2% of the cases (1). Isolated malleus shaft fractures are exceedingly rare in the clinic as well as in the literature with less than 100 published cases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, several authors underline that this condition is easily missed since the tympanic membrane is intact (2)(3)(4)(5)(6)(7)(9)(10)(11), thus leading to its underdiagnosis (3,4,7).…”

“…Isolated malleus shaft fractures are exceedingly rare in the clinic as well as in the literature with less than 100 published cases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, several authors underline that this condition is easily missed since the tympanic membrane is intact (2)(3)(4)(5)(6)(7)(9)(10)(11), thus leading to its underdiagnosis (3,4,7). In most recently published cases, the symptomatology of an isolated malleus fracture is similar, i.e., a short, sharp pain with a small to intermediate residual conductive hearing loss that occurs after the patient had used a finger to evacuate the wet ear canal after a shower or bath (3).…”