Isolated Traumatic Fracture of the Malleus Handle Causing Hearing Fluctuation

Handle of malleus fracture is a rare condition with <100 cases having been reported. The clinical presentation is conductive hearing loss following a history of trauma, typically, during manipulation of the external auditory canal. The diagnosis of the condition is clinical and radiological. The options for treatment are either a hearing aid or ossiculoplasty. We describe an isolated case of malleus handle fracture after trauma associated with manipulation of the external auditory canal.

A 56-year-old female, reported a right ear trauma. She suffered immediate otalgia, hearing loss and nonpulsatile tinnitus. An indistinct umbo was identified on endoscopic inspection and a hypermobile right tympanic membrane during Valsalva. Clinical testing of hearing revealed a mild-to-moderate conductive hearing loss. Computed Tomography scan revealed a fracture of the right malleus handle. A decision for surgical treatment was made based on continuing symptomatology as well as audiology and CT findings. A tragal composite cartilage graft was harvested and placed over the remaining superior part of the malleus and under the inferior fragment of the malleus attached to the tympanic membrane. The patient had immediate improvement of fluctuating hearing loss and tinnitus in the postoperative period.

A fracture of the malleus handle should be included in the etiologies of conductive hearing loss after trauma. A careful history, thorough otology examination, and a meticulous analysis of the CT will usually confirm this rare condition and exclude other ossicular abnormalities.