Rare pathophysiologic mechanism of isolated malleus shaft fractures

Traumatic middle ear lesions are a common picture in everyday clinical practice. In addition to tympanic membrane perforation, different localizations in the ossicular chain may be affected. A pattern of injury involving the malleus is rare in this regard and is reported in the literature to occur in 2%. A probably frequently unrecognized injury due to an intact tympanic membrane finding is the isolated malleus shaft fracture. Audiologically, conductive hearing loss is typically seen. Inspection with pneumatic ear otomicroscope may reveal increased movement of the malleus shaft distal to the fracture. A commonly described pathomechanism is the accidental creation of negative pressure with the finger in the wet external ear canal after bathing while trying to clear the ear canal of water. We report on a 50-year-old patient who presented to our outpatient clinic over 10 years after this pattern of injury with fluctuating hearing on the right side since then and subjective improvement of hearing after performing the Valsalva maneuver. Initially, there had been a post-traumatic onset of ear pain and vertigo lasting for several days. In another clinic, a Balloon Eustachian Tuboplasty had already been performed suspecting a dilatory (chronic obstructive) Eustachian tube dysfunction without any effect. In addition to a combined hearing loss, an excessive compliance could be detected in the tympanogram. In case of a possible interruption of the ossicular chain, tympanoscopy was indicated. After entering the tympanic cavity, a hypermobile ossicular chain with clear step formation in the malleus shaft was found. A type III tympanoplasty with a titanium PORP could be performed. In the follow-up examination three months after surgery, the patient reported stabilized hearing.

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Artikel online veröffentlicht:
12. Mai 2023