Recognition of malleus handle fracture in the differential diagnosis of otologic trauma.

We have had the opportunity to care for four patients who experienced barotrauma or implosive trauma to their ears. The differential diagnosis in these cases included ossicular injuries as well as possible perilymph fistulae. In each of these cases there was a small conductive hearing loss which fluctuated and a high compliance tympanogram. Careful otoscopy with the aid of pneumomassage revealed an isolated malleus handle (manubrium) fracture. Exploration of one ear was performed to rule out perilymph fistula and the diagnosis of malleus handle fracture was confirmed. Recognition of this injury preoperatively in these three other patients made exploration unnecessary. While injuries to the ossicular chain have been well-described in the literature, isolated malleus handle fracture has not been previously reported.