title: Handling an Isolated Malleus Handle Fracture: Current Diagnostic Work-up and Treatment Options.
abstract: BACKGROUND
  An isolated malleus handle fracture is rare and presents with vague otological symptoms. Diagnosis depends on careful history taking and otoscopic examination. Different treatment options are available. Reconstruction with hydroxyapatite bone cement is a relatively new technique.
  
  
  OBJECTIVE
  The aim of this article is to review the current diagnostic work-up and treatment options and to demonstrate our method of treatment with hydroxyapatite bone cement.
  
  
  METHODS
  Three cases, repaired with hydroxyapatite bone cement in a tertiary referral otologic center, were retrospectively analyzed. A review of the literature on diagnosis and treatment procedures was performed.
  
  
  RESULTS
  One fracture occurred by withdrawing a finger from the external auditory canal and 2 occurred without clear prior trauma. Our 3 cases were successfully repaired with hydroxyapatite bone cement.
  
  
  CONCLUSIONS
  Diagnosis of an isolated malleus handle fracture still depends on careful clinical examination. In addition to pure tone audiometry, both low and higher frequency tympanometry may be useful. High resolution computed tomography with reformatting through the malleus handle is the most accurate imaging modality. Reconstruction with hydroxyapatite bone cement is reliable by restoring the original situation with only minimal manipulation and without additional ossicular interruption.
authors.affiliation: European Institute for ORL-HNS, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium delrue.stefan@gmail.com.
authors.forename: Stefan
authors.initials: S
authors.lastname: Delrue
authors.affiliation: Department of Radiology, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: De Foer
authors.affiliation: European Institute for ORL-HNS, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium.
authors.forename: Joost
authors.initials: J
authors.lastname: van Dinther
authors.affiliation: European Institute for ORL-HNS, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Zarowski
authors.affiliation: European Institute for ORL-HNS, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Somers
authors.affiliation: Department of Radiology, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Casselman
authors.affiliation: European Institute for ORL-HNS, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Offeciers
mesh_terms: D000158:Acoustic Impedance Tests; D000328:Adult; D001301:Audiometry, Pure-Tone; D054893:Cone-Beam Computed Tomography; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008307:Malleus / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D038781:Otoscopy
keywords: conductive hearing loss; fracture; hydroxyapatite cement; malleus