Iurato S, Quaranta A
Department of Ophthalmology and Otolaryngology, University of Bari, Italy.
Am J Otol. 1999 Jan;20(1):19-25.
Isolated malleus-handle fracture is a clinical entity seldom reported in the medical literature but well known in the last century. The purpose of this paper was to review the literature over the last 150 years and describe three new cases.
Extensive review of the literature and chart review of three patients with isolated malleus-handle fracture.
The study was performed partly at a private practice and partly in an academic tertiary referral center.
At least 43 malleus-handle fractures have been reported in the literature. Three new occurrences were studied.
The review of the literature showed that head trauma with skull base fracture was the most frequent cause of malleus-handle fracture, followed by blows on the tympanic membrane and barotrauma, penetration of pen-holders or hair pins, penetration of twigs, and attempts to remove a foreign body pushed inside the ear. In the first patient reported here, the malleus-handle fracture was caused by a whirlpool bath, in the second, the cause was unknown, and, in the third, it was caused by a brisk decompression inside the ear canal.
This lesion is not rare, and the diagnosis frequently is missed because the tympanic membrane appears intact. A careful otoscopic examination with pneumomassage, an abnormally high compliance at tympanometry, and a carefully recorded medical history may lead to the diagnosis of isolated malleus-handle fracture in a patient with a mild conductive hearing loss.
孤立性锤骨柄骨折是一种在医学文献中很少报道但在上个世纪就已为人所知的临床病症。本文旨在回顾过去150年的文献并描述3例新病例。
对文献进行广泛回顾，并对3例孤立性锤骨柄骨折患者的病历进行回顾。
该研究部分在私人诊所进行，部分在学术性三级转诊中心进行。
文献中已报道至少43例锤骨柄骨折。对3例新病例进行了研究。
文献回顾表明，伴有颅底骨折的头部外伤是锤骨柄骨折最常见的原因，其次是鼓膜受击、气压伤、笔杆或发夹刺入、树枝刺入以及试图取出推入耳内的异物。在此报道的首例患者中，锤骨柄骨折由漩涡浴引起，第二例原因不明，第三例由耳道内快速减压引起。
这种损伤并不罕见，且由于鼓膜看似完整，诊断常常被漏诊。通过仔细的耳镜检查加鼓膜按摩、鼓室导抗图显示顺应性异常增高以及仔细记录的病史，可能会对轻度传导性听力损失患者做出孤立性锤骨柄骨折的诊断。
