An isolated fracture of the handle of the malleus is a rare entity in otorhinolaryngology and manifests clinically as acute-onset unilateral hearing loss. Several factors may cause this injury, including acute barotraumatic pressure changes or traumatic events. Various therapeutic approaches such as tympanoplasty, autologous graft, or application of bone cement are discussed. We report the case of a 46-year-old female patient who developed acute hearing loss in her left ear after finger manipulation. Clinical evaluation revealed axial displacement of the handle of the malleus and audiometry indicated conductive hearing loss. After otoscopy, audiometry, and computed tomography, tympanoscopy was indicated due to suspicion of ossicular chain disruption. Intraoperatively, an isolated fracture of the handle of malleus was found, which was treated with glass ionomer cement. Following postoperative examination, there was progressive improvement in the acoustic transmission component, such that a normal hearing threshold was observed 4 months postoperatively. This case report underlines the importance of precise diagnosis and individualized treatment for rare middle ear injuries.
UNASSIGNED: Die isolierte Hammergrifffraktur ist eine seltene, aber klinisch relevante Verletzung im Mittelohr, die zu einer einseitigen Hörminderung führt. Ursachen können akute Druckveränderungen oder traumatische Ereignisse sein. Verschiedene Therapieansätze wie Tympanoplastik, Transposition von autologem Material oder Applikation von Knochenzement werden diskutiert. In dieser Kasuistik wird eine 46-jährige Patientin mit einseitiger Hörminderung nach Manipulation im Ohr beschrieben. Klinisch zeigen sich eine Achsenfehlstellung des Hammergriffs und eine Schallleitungshörminderung in der Audiometrie. Die Verdachtsdiagnose lautet Unterbrechung der Gehörknöchelchenkette. Im Rahmen einer Tympanoskopie wird die Diagnose isolierte Hammergrifffraktur gestellt. Es wird in weiterer Folge Glasionomerzement zur Rekonstruktion des Hammergriffs verwendet. Postoperativ verbessert sich die Hörfunktion signifikant, mit einer vollständigen Remission der Hörminderung nach vier Monaten. Diese Kasuistik zeigt die Bedeutung einer umfassenden Diagnostik und Erfahrung des Operateurs bei der Auswahl der Therapie.

The cause of sudden conductive loss in the absences of other vestibulo-audiologic abnormalities can be isolated to specific subsites of the ossicular chain using audiometric testing. In the absence of such abnormalities, a rare etiology may be the cause after an inciting trauma. Laryngoscope, 2024.

BACKGROUND:  A clinical condition known as chronic otitis media (COM) is characterized by tympanic membrane perforation, varying degrees of hearing loss, and otorrhea that lasts for two to six weeks. COM alone or with cholesteatoma may result in ossicular chain discontinuity and ossicular erosion. The hearing restoration procedure includes repairing the eardrum and building the ossicular chain in ears with damaged ossicles. Multiple studies suggest the predictive value of preoperative air-bone gap (ABG) to detect the ossicular chain status can help with proper preoperative planning for surgery.
OBJECTIVE: To determine the degree of hearing improvement and reduction in ABG after tympanoplasty and to investigate the correlation between preoperative ABG and the status of the ossicular chain during surgery. Study design, setting, and date: This retrospective hospital file-based study was conducted at Aseer Central Hospital, Southern Region, Saudi Arabia, between November 2022 and April 2023. Hospital records of patients who underwent tympanoplasty during 2018-2023 were reviewed. Eighty-five patients were diagnosed with chronic suppurative otitis media (CSOM) between 2018 and 2023. A data collection sheet was employed to record extracted data, including the patient\'s age, sex, hearing assessment, type of surgical intervention, and outcome. We calculated the average of ABG decibels (dB) by summing the ABG values at 500 Hz, 1000 Hz, and 2000 Hz frequencies and dividing by three.
RESULTS: In the present study, data from 85 patients who underwent tympanoplasty were analyzed. Approximately one-third of the patients were in the age group of 31 to 40 years (25, 29.4%), and 50 (58.8%) of them were females. Chronic medical conditions were observed in 30 (35.3%) patients, with diabetes being reported in 19 (63.3%) of those cases. CSOM was found to be present in the left ear of 47 (56.0%) patients. Among the patients, 25 (29.4%) had subtotal perforations, 12 (14.1%) had marginal perforations, and two (2.4%) had total tympanic membrane perforations. The majority of patients (67, 78.8%) exhibited conductive hearing loss, while the remaining 18 (21.2%) had mixed hearing loss. Of the patients, 13 (15.3%) and 20 (23.5%) had fixed and disrupted ossicular chains, respectively. In terms of ossicular disruption, incudostapedial joint (ISJ) fixing (21.2%), fixed stapes (18.2%), and ISJ dislocation (18.2%) were the most prevalent kinds. Prior to operations, the mean ± SD of ABG was 22.6 ± 7.5. ABG values were 19.0 ± 9.3 on average after surgery. The statistical difference between pre- and postoperative ABG was statistically significant (paired t-test, p = 0.007), with a mean difference of -3.7. There were no significant differences between the different statuses of ossicular chains and the type of tympanic membrane perforation.
CONCLUSIONS: This study suggests that the degree of preoperative ABG (dB) is a valuable predictor of intraoperative ossicular chain status and can aid in preoperative planning for ossicular chain reconstruction. Furthermore, the study found that the type of tympanic membrane perforation preoperatively is not a reliable indicator of the ossicular chain status. Finally, tympanoplasty is considered a beneficial surgical procedure with a significant improvement in hearing status postoperatively.

OBJECTIVE: Although previous research has indicated inner ear changes in diabetes mellitus (DM) patients, no prior study has explored the middle ear, particularly the ossicles and their joints, in DM patients. This study aimed to investigate whether type 2 DM is associated with middle ear changes, specifically affecting the ossicular chain and joints.
METHODS: This study included 47 ears from 25 patients with DM (male = 13, female = 12, age: 51.0 ± 20.5) and age- and sex-matched controls (male = 10, female = 10, age: 54.8 ± 15.9) (sex; p = 1.000, Age; p = 0.991). Otopathological evaluations of the auditory ossicles and incudomalleolar joint (IMJ) were performed using light microscopy.
RESULTS: In the IMJ of DM cases, malleus hyalinized cartilage (Malleus hC) and incus hyalinized cartilage (Incus hC) were significantly increased compared with control cases (Malleus hC; DM, 34.17 ± 9.71 μm vs. control 21.96 ± 4.16 μm, p < 0.001) (Incus hC; DM 35.11 ± 10.12 μm vs. control 22.42 ± 4.368 μm, p < 0.001). In addition, bone-line distance was significantly longer than in DM cases than control cases (DM 266.72 ± 59.11 μm vs. control 239.81 ± 35.56 μm p = 0.040). On the other hand, joint discus distance was longer in the control group than in DM cases (DM 96.84 ± 36.80 μm vs. Control 113.63 ± 23.81 μm, p = 0.001).
CONCLUSIONS: This study reveals a notable increase in the hyalinized cartilage layer and bone-line distance accompanied by reducing joint discus distance within the IMJ in DM cases. These findings suggest that DM may influence microjoints, such as the IMJ, and potentially impact auditory function.
METHODS: N/A Laryngoscope, 134:2871-2878, 2024.

BACKGROUND: Hearing loss caused by middle ear malformations is treated by tympanoplasty to reconstruct the acoustic conduction system. The mobility of the ossicles plays a crucial role in postoperative success. However, identifying the location of ossicular malformation based solely on preoperative audiograms is challenging due to the complex relationship between fixation location, deformity levels, and ossicular mobility.
METHODS: Middle ear finite element models for simulating ossicular malformations were created, and the results were compared with the actual preoperative audiograms.
RESULTS: This approach objectively diagnosed ossicular fixation and disarticulation, bypassing traditional criteria reliant on physician examination or imaging.
CONCLUSIONS: This study suggests that future research should focus on developing a diagnostic framework utilizing large-scale data.

OBJECTIVE: To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round window atresia of dysplasia.
METHODS: Pubmed/Medline, Embase and Cochrane library.
METHODS: Articles containing data on hearing outcomes and complications after reconstructive ear surgery in class 4 anomalies were analyzed and critically appraised. The following data were included and reviewed: patient demographics, audiometric testing, surgical techniques, complications, revision surgeries and their outcomes. Risk of bias was determined, and GRADE certainty of evidence was assessed. Primary outcomes were postoperative air conduction thresholds (AC), change in AC, and success rates (closure of the ABG to within 20 dB), the occurrence of complications (most importantly sensorineural hearing loss) and the long-term stability of hearing results (> 6-month follow-up) and occurrence of recurrence of preoperative hearing loss.
RESULTS: Success rates varied from 12.5 to 75% at long-term follow-up with larger cohorts reporting success rates around 50%, mean postoperative gain in AC varied from 4.7 to 30 dB and - 8.6 to 23.6 dB at, respectively, short- and long-term follow-up. No postoperative change in hearing occurred in 0-33.3% of ears, and recurrence of hearing loss occurred in 0-66.7% of ears. SNHL occurred in a total of seven ears across all studies of which three experienced complete hearing loss.
CONCLUSIONS: Reconstructive surgery can be an effective treatment option which should be considered in patients with very favorable baseline parameters, while also considering the substantial risk of recurrence of hearing loss, the possibility of unchanged hearing despite surgery and the rare occurrence of SNHL.
METHODS: 2c.

OBJECTIVE: To summarize the clinical characteristics of glomus tympanicum tumors, and to explore the surgical methods and the strategy for auditory protection.
METHODS: Ten cases (ears) of glomus tympanicum tumors were collected from the Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University from August 2014 to February 2022. All patients underwent endoscopic or microscopic surgery to achieve total removal of the tumor, followed up for 3 months to 8 years. We summarized and analyzed its clinical characteristics, compared the preoperative and postoperative hearing levels of patients, and made a retrospective summary of the surgical methods and the strategy for auditory protection.
RESULTS: Ten patients were all female at (49.50±8.00) years old. Their medical history ranged from 15 days to 6 years. Seven patients complained of pulsatile tinnitus, and 80% (8/10) of the affected ears suffered different degrees of hearing loss. According to the modified Fisch & Mattox classification of glomus tympanicum tumors, 3 ears (30%) of 10 ears were A1, 2 ears (20%) were A2 and 5 ears (50%) were B1. In all 10 cases (ears), hearing was improved in 3 cases, bone gas conductance was maintained in 6 cases, and hearing was slightly decreased in 1 case. The difference of bone gas conductance was 0-10 dB in 7 cases (ears) after operation, and 10-20 dB in 3 cases (ears). There was no significant difference in the average air conduction hearing threshold, bone conduction hearing threshold and air-bone conduction difference between before and after operation (all P>0.05). All cases had no postoperative complications, and the external auditory canal and the incision behind the ear healed well. There was no recurrence after follow-up.
CONCLUSIONS: Glomus tympanicum tumor is easy to bleed, so it is a challenge for total tumor resection and hearing function protection during operation. For type A and type B1 tumors, they can be completely removed under the condition of keeping the tympanic membrane and the ossicular chain. At the same time, the postoperative hearing function can be preserved, and even the hearing can be improved.
目的: 总结鼓室体瘤临床特征，探讨手术方式及入路选择以及术中听觉保护的策略。方法: 收集中南大学湘雅医院耳鼻咽喉头颈外科2014年8月至2022年2月确诊为鼓室体瘤的10例(耳)患者的临床资料，全部患者均接受内镜或显微镜手术实现肿瘤全切，术后随访3个月~8年；结合文献分析归纳其临床特征，比较患者术前、术后听力水平，对手术方式及入路选择、听觉保护等手术策略进行回顾性总结。结果: 10例患者均为女性，年龄(49.50±8.00)岁，病史15 d~6年，7例主诉为搏动性耳鸣，80%(8/10)患耳有不同程度的听力下降。根据改良版Fisch & Mattox鼓室体瘤分型，10例术耳中3耳为A1型(30%)，2耳为A2型(20%)，5耳为B1型(50%)。全部10例(耳)中3例术耳听力较术前提升，6例术耳气导维持术前听力，1例术耳听力较前稍下降。7例(耳)术后骨气导差为0~10 dB，3例(耳)骨气导差为10~20 dB。术前、术后的平均气导听阈、骨导听阈、气骨导差的差异均无统计学意义(均P>0.05)。所有患者术后均无并发症发生，术后外耳道及耳后切口均愈合良好。术后随访均无复发。结论: 鼓室体瘤因极易出血，在手术中同时兼顾肿瘤全切和听功能保护极具挑战性。对于A型及B1型鼓室体瘤，手术中可以争取在保持鼓膜完整、保留听骨链的前提下彻底去除肿瘤，并同时保留术后听功能，甚至较术前听力有所提高。.

OBJECTIVE: Establish normal reference values for the human malleus during the second and third trimesters of pregnancy, and describe its growth dynamics and ossification process.
METHODS: Thirty spontaneously aborted human fetuses, 12-36 weeks of age, were examined. Temporal bones were obtained en bloc and processed using the skeletal clearing and staining technique. Each malleus was obtained by microdissection. Measurements of anatomical points of the malleus were performed. Ossification was recorded. Statistics were applied.
RESULTS: Sixty mallei were obtained. At the end of development, the following measurements were obtained in millimeters: head length, 2.87 (2.30-3.44); neck length, 1.15 (0.92-1.38); manubrium length, 4.45 (3.75-5.16); total length, 8.51 (8.02-8.99); neck width, 1.33 (0.70-1.97); manubrium width, 0.84 (0.82-0.86); and Meckel cartilage width, 0.43 (0.06-0.95). The angle of the longitudinal axis of the malleus was 160° (156-164°). The ossification process of the malleus followed a stereotyped pattern that began at week 16, at the level of the neck, with a single center that expanded to the head and then to the manubrium. Toward the end of development, only the umbo remained cartilaginous. There were no sex-based differences in human malleus size during prenatal development. From the beginning of the second trimester of pregnancy, the longitudinal axis of the malleus acquires dimensions comparable to adults.
CONCLUSIONS: The study of the malleus development provides clues that would explain some anomalies in its development, and can influence decision-making during the placement and design of prostheses in the malleus.

OBJECTIVE: To evaluate patients\' hearing outcomes after ossicular chain reconstruction using unmodified autologous incus.
METHODS: A single-centred, retrospective study of patients who underwent incus interposition between June 2010 and October 2017 was conducted at a Dutch secondary referral centre. This paper describes a chart review of patients who presented with erosion of the long process of the incus due to atelectasis or cholesteatoma who were treated with an unmodified incus interposition. The main outcome measures were: post-operative air-bone gap and level of air-bone gap closure.
RESULTS: Thirty-three ears of 32 patients were included. Follow-up duration ranged from six weeks to seven years. A mean post-operative air-bone gap under 25 dB was considered successful; this was achieved in 25 patients (76 per cent), 20 (91 per cent) in the partial ossicular reconstruction prosthesis group and 5 (45 per cent) in the total ossicular reconstruction prosthesis group. This difference was statistically significant (p = 0.007).
CONCLUSIONS: Successful preservation and improvement of hearing was observed in most patients. As expected, the closure rate in the partial ossicular reconstruction prosthesis group was better. Longer follow-up studies with larger case numbers are needed to assess whether further reconstruction techniques are necessary.

Human auditory ossicles, the malleus, the incus, and the stapes, are located in the tympanic cavity in the temporal bone and through forming a chain for the sound transmission from the tympanic membrane to the cochlea, they play an important role in the hearing process. Despite their clinical, phylogenetic, and evolutionary significance, the morphometry of the human ear bones has not been examined systematically. The ear ossicles are the smallest bones of the human skeleton, attaining their final size and morphology already at birth. Initially, they have been found to exhibit minimal morphometric variation, but further studies brought the opposite results. The aim of this study was to examine the morphometric variation of human auditory ossicles recovered from medieval and postmedieval subadult skeletons from Poland, Central Europe. The analysis involved in a total of 166 ear bones. Their measurements were performed on microscopic images using CorelDraw x4, according to a protocol of Quam and Rak with modification of Flohr et al. and Wadhwa et al. Our study showed a significant metric variation in the measurements taken at areas of the greatest morphological variability of the ossicles. We found that greater linear dimensions were associated with lower values of angular measurements. These results reveal the inherent variation found in these supposed functionally constrained structures. Representation of even greater number of populations, time periods, and developmental stages are needed. Further study will expand our understanding of the global scope of variation found in ear ossicular morphology and its functional implications for paleoanthropology.