Recognition of malleus handle fracture in the differential diagnosis of otologic trauma

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Abstract
We have had the opportunity to cure for four patients who experienced barotrauma or implosive trauma to their ears. The differential diagnosis in these cases included ossicular injuries as well us possible perilymph fistulae. In euch of these cases there was a small conductive hearing loss which fluctuated and u high compliance tympnnogrnm. Careful otoscopy with the ald of pneumomassage revealed un isolated malleus handle (manubrium) fracture. Exploration of one ear was performed to rule out perilymph fistula und the diagnosis of malleus handle fracture was confirmed. Recognition of this injury preoperntively in these three other patients made exploration unnecessary. While injuries to the ossiculnr chain have been well-described in the literature, isolated malleus handle fracture has not been previously reported. The salient features of the presenting symptoms, diagnostic signs, und laboratory findings will be discussed and illustrated.

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