Isolated malleus-handle fracture

Objective: Isolated malleus fracture is a rare ossicular injury with less than 80 cases published in the literature. The aim of this paper is to present a series of 3 patients with isolated malleus handle fracture, to review the literature and to discuss clinical presentation, imaging findings and treatment options. Methods: We retrospectively a case series of 3 patients with isolated malleus handle fracture managed at a tertiary referral otologic center. Results: The three patients related the same history of digitally manipulating the external auditory canal, leading to a sudden hearing loss and feeling of aural fullness. Meticulous otomicroscopy revealed the broken malleus with excessive movement of the distal part of the malleus on pneumatic otoscopy. High-resolution CT scan with multiplanar reconstruction along the axis of the malleus confirmed the fractures and displacements. One patient was treated conservatively and two underwent ossiculoplasty. 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.