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Isolated fracture of the manubrium of the malleus
W Chien1, M J McKenna, J J Rosowski
1Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA. wadechien@hotmail.com
Objective:
To describe a series of five patients with isolated fracture of the manubrium of the malleus.
Design:
Retrospective case series.
Subjects:
Five patients aged 44-64 years with isolated fracture of the manubrium who presented to our institution over a five-year period (2000-2005).
Results:
All patients presented with a history of digitally manipulating the external auditory canal, leading to the manubrial fracture, which we presume was due to a suction-type mechanism. Otomicroscopy often revealed a break in the smooth contour of the manubrium. All patients had air-bone gaps on audiometry, especially at higher frequencies. Tympanometry showed hypermobility of the tympanic membrane in four patients who were tested. Laser-Doppler vibrometry revealed increased umbo velocity in four out of five patients. Four patients were treated conservatively. One patient underwent exploratory tympanotomy with successful ossiculoplasty.
Conclusions:
Isolated fracture of the manubrium is a rare condition which may present as sudden-onset hearing loss after digital manipulation of the external auditory canal. The diagnosis can be made on the basis of otomicroscopy, audiometry, tympanometry and laser-Doppler vibrometry. Conservative treatment is often successful.
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Assessment:
1. Clinical Evaluation:
History: