A Case of Idiopathic Malleus Handle Fracture

Abstract

The most common injury of the ossicle chain is traumatic incudostapedial joint dislocation. Cases of fracture of the incus or stapes have also been reported, but malleus fracture without injury of the tympanic membrane or other ossicles is rare. Our patient was a 56-year-old man who presented to our outpatient department with an 8-day history of right hearing loss at the time of waking up. On examination, the anterior part of the right tympanic membrane looked dark purple. Pure-tone audiogram showed mid-to-high frequency conductive hearing loss on the right side. A temporal bone CT showed no obvious fracture of the ossicles, but an opacity was noted anterior to the malleus handle, suggesting middle ear hemorrhage. Eight months later, endoscopic ear surgery was performed. The fracture was located near the lateral process of the malleus, and a tragus cartilage graft was placed between the malleus and the tympanic membrane. Postoperatively, the right conductive hearing loss improved. Although isolated malleus handle fracture is rare, it is necessary to keep in mind the possibility of such ossicular bone injuries in daily practice.