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Ear, Nose, & Throat Journal Nov 2023We report a rare case of isolated malleus dislocation into the external auditory canal with lateralized intact tympanic membrane following a head trauma. The patient was...
We report a rare case of isolated malleus dislocation into the external auditory canal with lateralized intact tympanic membrane following a head trauma. The patient was a 63-year-old woman who presented at the outpatient department of our institute with hearing loss of 10 years' duration after a bicycle accident. During physical examination of the patient, total dislocation of the malleus-like bony structure into the external auditory canal on the right side was observed. In the computed tomography scan, an isolated malleus dislocation with intact incus-stapes articulation was identified. The patient was successfully treated with endoscopic exploratory tympanotomy and partial ossicular replacement prosthesis. The isolated malleus dislocation can rarely occur after trauma. A careful diagnostic step through history, physical examination, and temporal bone computed tomography scan are needed to confirm this rare condition.
Topics: Female; Humans; Middle Aged; Malleus; Ear Canal; Incus; Stapes; Ossicular Prosthesis
PubMed: 34191618
DOI: 10.1177/01455613211026529 -
Journal of Anatomy Dec 2016It is widely accepted by developmental biologists that the malleus and incus of the mammalian middle ear are first pharyngeal arch derivatives, a contention based...
It is widely accepted by developmental biologists that the malleus and incus of the mammalian middle ear are first pharyngeal arch derivatives, a contention based originally on classical embryology that has now been backed up by molecular evidence from rodent models. However, it has been claimed in several studies of human ossicular development that the manubrium of the malleus and long process of the incus are actually derived from the second arch. This 'dual-arch' interpretation is commonly presented in otolaryngology textbooks, and it has been used by clinicians to explain the aetiology of certain congenital abnormalities of the human middle ear. In order to re-examine the origins of the human malleus and incus, we made three-dimensional reconstructions of the pharyngeal region of human embryos from 7 to 28 mm crown-rump length, based on serial histological sections from the Boyd Collection. We considered the positions of the developing ossicles relative to the pharyngeal pouches and clefts, and the facial and chorda tympani nerves. Confirming observations from previous studies, the primary union between first pharyngeal pouch and first cleft found in our youngest specimens was later lost, the external meatus developing rostroventral to this position. The mesenchyme of the first and second arches in these early embryos seemed to be continuous, but the boundaries of the developing ossicles proved to be very hard to determine at this stage. When first distinguishable, the indications were that both the manubrium of the malleus and the long process of the incus were emerging within the first pharyngeal arch. We therefore conclude that the histological evidence, on balance, favours the 'classical' notion that the human malleus and incus are first-arch structures. The embryological basis of congenital ossicular abnormalities should be reconsidered in this light.
Topics: Embryonic Development; Humans; Incus; Malleus
PubMed: 27456698
DOI: 10.1111/joa.12520 -
Otology & Neurotology : Official... Mar 2019Handle of malleus fracture is a rare condition with <100 cases having been reported. The clinical presentation is conductive hearing loss following a history of trauma,...
INTRODUCTION
Handle of malleus fracture is a rare condition with <100 cases having been reported. The clinical presentation is conductive hearing loss following a history of trauma, typically, during manipulation of the external auditory canal. The diagnosis of the condition is clinical and radiological. The options for treatment are either a hearing aid or ossiculoplasty. We describe an isolated case of malleus handle fracture after trauma associated with manipulation of the external auditory canal.
CASE REPORT
A 56-year-old female, reported a right ear trauma. She suffered immediate otalgia, hearing loss and nonpulsatile tinnitus. An indistinct umbo was identified on endoscopic inspection and a hypermobile right tympanic membrane during Valsalva. Clinical testing of hearing revealed a mild-to-moderate conductive hearing loss. Computed Tomography scan revealed a fracture of the right malleus handle. A decision for surgical treatment was made based on continuing symptomatology as well as audiology and CT findings. A tragal composite cartilage graft was harvested and placed over the remaining superior part of the malleus and under the inferior fragment of the malleus attached to the tympanic membrane. The patient had immediate improvement of fluctuating hearing loss and tinnitus in the postoperative period.
CONCLUSION
A fracture of the malleus handle should be included in the etiologies of conductive hearing loss after trauma. A careful history, thorough otology examination, and a meticulous analysis of the CT will usually confirm this rare condition and exclude other ossicular abnormalities.
Topics: Craniocerebral Trauma; Fractures, Bone; Hearing Loss, Conductive; Humans; Male; Malleus; Middle Aged
PubMed: 30741902
DOI: 10.1097/MAO.0000000000002111 -
Acta Oto-laryngologica Jan 2021There are many reports on the role of the malleus handle in ossicular chain reconstruction (OCR). However, the effect of the presence of the malleus handle is not clear. (Comparative Study)
Comparative Study
BACKGROUND
There are many reports on the role of the malleus handle in ossicular chain reconstruction (OCR). However, the effect of the presence of the malleus handle is not clear.
AIM/OBJECTIVES
To compare the hearing outcomes of using a partial ossicular replacement prosthesis (PORP) to reconstruct the ossicular chain under otoendoscopy with and without a malleus handle.
METHODS
Records of 57 patients requiring OCR were retrospectively analyzed. They were divided into the malleus handle-present group (group 1) and the malleus handle-absent group (group 2). The audiometric results were analyzed pre- and postoperatively. A postoperative air-bone gap (ABG)≤20 dB was considered successful.
RESULTS
The mean improvement in air conduction hearing thresholds was 19.80 dB in group 1 and 16.70 dB in group 2. The mean ABG improvement was 18.09 ± 12.79 dB for group 1 and 17.20 ± 16.44 dB for group 2. The malleus handle-present group achieved higher success (65.63%) than the malleus handle-absent group (52%; > .05).
CONCLUSIONS AND SIGNIFICANCE
Improvements in hearing outcomes were similar for the two groups. However, the malleus handle-present group showed a better reconstruction success rate. Our results suggest that if there is no lesion in the malleus handle, it is recommended to be retained.
Topics: Adult; Aged; Audiometry; Bone Conduction; Ear Ossicles; Female; Hearing Loss; Hearing Tests; Humans; Male; Malleus; Middle Aged; Ossicular Prosthesis; Ossicular Replacement; Retrospective Studies; Treatment Outcome; Tympanoplasty; Young Adult
PubMed: 33063573
DOI: 10.1080/00016489.2020.1815835 -
Otology & Neurotology : Official... Apr 2010Malleus bar is a rare cause of conductive hearing loss and has yet to be described in the setting of congenital aural atresia. This study aimed to define the anomaly and...
OBJECTIVES
Malleus bar is a rare cause of conductive hearing loss and has yet to be described in the setting of congenital aural atresia. This study aimed to define the anomaly and review the surgical management and outcomes of patients found to have a malleus bar in the setting of congenital aural atresia.
STUDY DESIGN
Retrospective case review of patients with malleus bar and congenital aural atresia.
SETTING
Tertiary otologic referral center.
PATIENTS
Patients found to have a malleus bar at the time of surgery for congenital aural atresia.
METHODS
Charts of patients who underwent surgery for congenital aural atresia repair with a malleus bar were reviewed for demographic data, preoperative Jahrsdoerfer score, surgical findings, and audiometric data.
RESULTS
Seven subjects (8 ears) were identified to have a malleus bar and congenital aural atresia. In all 8 ears, the malleus bar proved to be a second point of attachment of the ossicular chain in addition to the atretic plate. The chorda tympani nerve was found in the bony bar in 4 patients. Closure of the air-bone gap within 35 dB hearing level (HL) was achieved in 83% of patients. All patients showed improved speech reception thresholds and stable bone-conduction thresholds. All but 1 patient had stable or improved word recognition scores.
CONCLUSION
Malleus bar in the setting of congenital aural atresia represents a rare combination of causes of congenital conductive hearing loss. Patients with these 2 abnormalities obtain good short-term results with surgical repair of congenital aural atresia.
Topics: Audiometry, Pure-Tone; Bone Conduction; Child; Child, Preschool; Databases, Factual; Ear Canal; Female; Hearing Loss, Conductive; Humans; Male; Malleus; Retrospective Studies; Treatment Outcome
PubMed: 20061990
DOI: 10.1097/MAO.0b013e3181ca846e -
American Journal of Otolaryngology 2018To anatomically describe a cartilaginous cap attached to the lateral process of the malleus.
PURPOSE
To anatomically describe a cartilaginous cap attached to the lateral process of the malleus.
STUDY DESIGN
Histologic and gross anatomic review.
METHODS
Twenty temporal bones were histologically reviewed. The anatomical relationship between the tympanic membrane and malleus was then defined at the level of the lateral process of the malleus and the long process of the malleus. Separately, gross evaluation of these levels at the macroscopic level was undertaken through endoscopic imaging in five subjects.
RESULTS
All temporal bones reviewed revealed the presence of a cartilaginous cap articulating between the tympanic membrane and the lateral process of the malleus. The cartilaginous cap was also readily identifiable in gross evaluation of the tympanic membrane from views lateral and medial to the tympanic membrane during endoscopic evaluation.
CONCLUSION
The cartilaginous cap of the lateral process of the malleus is an important and reliable anatomical structure of the middle ear that has not previously been described. Through knowledge of the structure surgeons may exploit its presence by creating a cleavage plane between the cartilaginous cap and the malleus during tympanoplasty, possibly allowing for safer and more efficient surgery.
Topics: Cadaver; Cartilage; Ear, Middle; Endoscopy; Humans; Malleus; Temporal Bone; Tympanic Membrane
PubMed: 29229399
DOI: 10.1016/j.amjoto.2017.10.010 -
The Laryngoscope Aug 1981Primary malleus fixation occurs in an otherwise normal middle ear without evidence of congenital deformity and without chronic inflammatory changes. It occurs in the...
Primary malleus fixation occurs in an otherwise normal middle ear without evidence of congenital deformity and without chronic inflammatory changes. It occurs in the latter decades of life and is frequently associated with sensorineural presbycusis. We believe it is a ligament ankylosis with osteoarthritis related to the aging process. The diagnosis of malleus fixation is facilitated through the use of a modified Siegle pneumatic otoscope in conjunction with the Zeiss binocular microscope. The literature pertaining to this subject as well as the more historical reports are reviewed. Goodhill has written extensively on malleus fixation. The audiologic test results in the fixed malleus cases reviewed for this study often presented a misleading picture, sometimes mimicking stapedial otosclerosis with a characteristic Carhart's notch and sometimes indistinguishable from sensorineural presbycusis. Usually speech discrimination scores fell in the very good to excellent range. Weber tests, whether performed by tuning forks or audiometrically, almost always lateralized to the suspect ear. Impedance frequently failed to conform to the expected fixed malleus pattern of low static compliance and absent acoustic reflexes; there was an equal number of low compliance and normal range compliance tympanograms and 15% of the total number of our cases had abnormally high compliance tympanograms. Stapedial reflexes are normally expected to be absent with lateral ossicular fixation, but this was not a consistent finding with contralateral test stimulation. The decision for surgical treatment is dependent on the audiological findings and the potential hearing gain. The technique described consists of the removal of the incus and the head of the malleus and the reconstruction of a sound conducting pathway from the handle of the malleus to the mobile stapes or from the mobile stapes to the under surface of the tympanic membrane using a prosthesis-ossicle arrangement. Malleus fixation occurs far more often than it is diagnosed. Surgical correction can result in a worthwhile hearing gain even when the air-bone gap is narrow or nonexistent. The technique of ossicular reconstruction is dictated by the anatomical findings. Some form of autograft ossicular reconstruction from the malleus handle to the stapes is most frequently utilized. Otosclerosis with stapes fixation sometimes causes a lateral ossicular fixation due to degenerative disease and fibrosis. In this instance a stapedectomy is performed as the primary procedure with subsequent revision as necessary to eliminate the lateral obstruction.
Topics: Audiometry; Ear Diseases; Ear Ossicles; Hearing Disorders; Humans; Malleus; Ossification, Heterotopic; Otosclerosis
PubMed: 6790887
DOI: 10.1288/00005537-198108000-00012 -
The Laryngoscope Feb 2018To determine the longitudinal effectiveness of the malleus to oval window stapedotomy technique among patients undergoing revision surgery when the incus is unavailable.
OBJECTIVE
To determine the longitudinal effectiveness of the malleus to oval window stapedotomy technique among patients undergoing revision surgery when the incus is unavailable.
STUDY DESIGN
Retrospective, case series.
METHODS
Charts of 15 patients who underwent 17 malleus attachment stapedotomies performed by a single surgeon from 2000 to 2015 were reviewed. Surgery was ambulatory, transcanal, with laser technique, and under local anesthesia.
RESULTS
Of 17 stapedotomies performed, there were nine first revisions, six second revisions, one third revision, and one fourth revision. There were no surgical complications. Mean preoperative air-bone gap (ABG) was 32.3 dB. Mean postoperative ABG at 6 months was 10.7 dB, and at last follow-up was 16.3 dB. Average length of follow-up was 36.5 months. At last follow-up, 100% of first revisions achieved ABG ≤ 20 dB (77.8% ≤ 10 dB), compared to 50% of second revisions with ABG ≤ 20 dB (none ≤ 10 dB), and 0% of third or fourth revisions with ABG ≤ 20 dB. Trend lines for second and third/fourth revisions showed a deterioration (widening) in postoperative ABG by 0.18 and 0.72 dB per month, respectively. The first-revision trend line, conversely, showed negligible change with time, demonstrating the superior durability of first revisions compared to subsequent surgeries.
CONCLUSION
The malleus to oval window stapedotomy technique is more effective and longer lasting in first-revision surgery compared to subsequent procedures. Standard or implantable amplification devices may be preferable for patients with multiple prior procedures.
LEVEL OF EVIDENCE
4. Laryngoscope, 128:461-467, 2018.
Topics: Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Auditory Threshold; Female; Humans; Longitudinal Studies; Male; Malleus; Middle Aged; Oval Window, Ear; Reoperation; Retrospective Studies; Stapes Surgery; Treatment Outcome
PubMed: 28498487
DOI: 10.1002/lary.26622 -
The Annals of Otology, Rhinology, and... Jun 2016To evaluate the effectiveness of malleus to stapes bone cement rebridging (MS-BCR) for Austin Kartush group A ossicular defects and compare the audiological results with...
OBJECTIVE
To evaluate the effectiveness of malleus to stapes bone cement rebridging (MS-BCR) for Austin Kartush group A ossicular defects and compare the audiological results with incus interposition (IP) and incus to stapes bone cement rebridging (IS-BCR).
METHODS
Patients for whom type 2 tympanoplasty had been performed in a tertiary referral center were examined. Revision cases and those with graft failure were excluded. Three treatment groups were IS-BCR, IP, and MS-BCR. Preoperative and postoperative audiological results were compared.
RESULTS
A total of 92 patients were enrolled. The IS-BCR was performed in 42 (45.65%), IP in 18 (19.56%), and MS-BCR in 32 (34.78%) patients. Postoperative mean air bone gap was 20.1 ± 9.8 dB HL and did not differ significantly between the groups (P = .271). Postoperative mean air bone gap less than 20 dB HL was achieved in 23 (54.7%) patients in IS-BCR, 10 (55.5%) patients in IP group, and 24 (75%) patients in MS-BCR group (P = .06). Mean closure in air bone gap was 14.0 ± 11.6 dB HL. The changes in mean and frequency-specific air bone gap were not significantly different between treatment groups (P > .05).
CONCLUSION
Malleus to stapes bone cement rebridging may provide hearing results comparable to IS-BCR and IP.
Topics: Adolescent; Adult; Aged; Audiometry, Pure-Tone; Bone Cements; Child; Cholesteatoma, Middle Ear; Chronic Disease; Female; Hearing Loss, Conductive; Humans; Incus; Male; Malleus; Mastoid; Middle Aged; Ossicular Replacement; Otitis Media; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome; Tympanoplasty; Young Adult
PubMed: 26631763
DOI: 10.1177/0003489415618678 -
American Journal of Otolaryngology 2003
Review
Topics: Adolescent; Bone Neoplasms; Hearing Disorders; Humans; Male; Malleus; Osteoma
PubMed: 12884215
DOI: 10.1016/s0196-0709(03)00023-1