Fracture of the manubrium of malleus after manipulation in external auditory meatus, a case report

Fracture of the manubrium of the malleus by acute pressure change after a manipulation is a rare complication. The main symptom is conductive hearing loss.

Case report: 51 (case 1) and 82 (case 2) years old patients described an acute hearing loss after a suddenly pulling the finger from the external auditory canal. The tympanic membrane was lateralized under the microscope in case 1 and had hematoma in case 2. The pure tone audiogram showed an air bone gap up to 40 dB in both cases. With a suspicion of fracture of the manubrium of the malleus an exploratory tympanotomy was done and the suspicion diagnosis was confirmed. The rest of the ossicular chain was intact and mobile. The ossiculoplasty was achieved with OtoMimix in both cases. The postoperative tone audiogram revealed a recovery of the air-bone gap until 12,5 dB at 0.5, 1, 2 und 4 kHz.

Fracture of the manubrium of the malleus after a digitally manipulation in the ear canal is a rare complication with less than 100 cases having been reported in the literature. The most cases happen after a head trauma, an explosion trauma, a foreign body perforation or an extirpation of a foreign body. The diagnosis can be made on the basis of detailed story, otomicroscopy, audiometry with conductive hearing loss especially at higher frequencies and a significant tympanometry. A CT-scan can be helpful and exclude the anomalies in the rest of the ossicular chain. Therapy options are conservative, reposition with cement or cartilage and rarely tympanoplasty with prosthesis. The prognosis is over all good.

Conclusion The therapy is based on the symptoms especially the grade of hearing loss. The decision of conservative or surgical therapy should be made after detailed discussion with the patient.

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Publication History

Article published online:
13 May 2021