Malleus handle probe: a middle ear diagnostic procedure.

Manual probing of the malleus handle (MH) of 477 patients suggests a protective middle ear reflex with a variable tonic contraction of the tensor tympani muscle (TTM). The degree and type of MH retraction suggests three stages of progressive middle ear inflammation. Prediction accuracy of 250 myringotomy findings was 60% with impedance audiometry and 92% with MH probing. Mechanical pressure gauge readings (grams) of 202 ears correlated with finger pressure estimations. The TTM tendons were sectioned in ten children with persisting otitis media with effusion (OME) and seven obtained benefit. The three diagnostic methods, pneumatic otoscopy, impedance audiometry and MH probing, assess similar and separate perimeters and are complementary. Malleus handle probing alone detects attic loculation of OME, 54 of 954 ears (5.6%). it extends the diagnostic range to the TTM activities.