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Isolated fracture of the manubrium of the malleus

Published online by Cambridge University Press:  26 November 2007

W Chien ,
M J McKenna ,
J J Rosowski  and
S N Merchant
W Chien*
Affiliation:
Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
M J McKenna
Affiliation:
Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
J J Rosowski
Affiliation:
Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Division of Health Sciences and Technology, Harvard University–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
S N Merchant
Affiliation:
Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Division of Health Sciences and Technology, Harvard University–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
*
Address for correspondence: Dr Wade Chien, 243 Charles Street, Boston, MA 02114, USA. Fax: +1 (978) 470 2679 E-mail: wadechien@hotmail.com
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Abstract

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.

Keywords

MalleusFractureConductive Deafness
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 9 , September 2008 , pp. 898 - 904
Copyright
Copyright © JLO (1984) Limited 2007

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