title: Isolated malleus-handle fracture.
abstract: OBJECTIVE
  Isolated malleus fracture is a rare ossicular injury with less than 80 cases published in the literature. The aim of this paper is to present a series of 3 patients with isolated malleus handle fracture, to review the literature and to discuss clinical presentation, imaging findings and treatment options.
  
  
  METHODS
  We retrospectively a case series of 3 patients with isolated malleus handle fracture managed at a tertiary referral otologic center.
  
  
  RESULTS
  The three patients related the same history of digitally manipulating the external auditory canal, leading to a sudden hearing loss and feeling of aural fullness. Meticulous otomicroscopy revealed the broken malleus with excessive movement of the distal part of the malleus on pneumatic otoscopy. High-resolution CT scan with multiplanar reconstruction along the axis of the malleus confirmed the fractures and displacements. One patient was treated conservatively and two underwent ossiculoplasty.
  
  
  CONCLUSIONS
  Malleus handle fracture should be systematically suspected in case of hearing loss and aural fullness of sudden onset after digital manipulation of the external auditory canal.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Fondation Adolphe de Rothschild, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Blanchard
authors.forename: Avraham
authors.initials: A
authors.lastname: Abergel
authors.forename: Benjamin
authors.initials: B
authors.lastname: Vérillaud
authors.forename: Marc T
authors.initials: MT
authors.lastname: Williams
authors.forename: Denis
authors.initials: D
authors.lastname: Ayache
mesh_terms: D004424:Ear Canal; D005260:Female; D005385:Fingers; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008307:Malleus / Q000293:injuries*; D008405:Massage / Q000009:adverse effects; D008875:Middle Aged; D013506:Otologic Surgical Procedures; D038781:Otoscopy; D035583:Rare Diseases; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods