{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T17:17:55Z","timestamp":1758820675212,"version":"3.40.5"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T00:00:00Z","timestamp":1692144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide suggestions for management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>PubMed, Embase, Cochrane Library.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>Retrospective cohort study was performed on 12 patients with isolated malleus fractures. History, physical exam, pre\u2010 and post\u2010treatment audiograms, and imaging were obtained. Systematic review of the literature was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Including the cases herein, 58 isolated malleus fractures were identified, the majority of which were published in the 21st century. Mean time to presentation after injury was 34.4\u2009months. Most common etiology was external auditory canal (EAC) manipulation. Physical exam and imaging did not identify any abnormality at presentation in 16% and 21% of cases, respectively. The majority of fractures involved the manubrium. Air\u2010bone gap (ABG) at initial presentation ranged from 16 to 26\u2009dB, and was greater at higher frequencies. Thirty\u2010six cases underwent surgery. ABG improvement was greater at all frequencies for those who underwent surgery. Final ABG was significantly less than initial ABG at nearly every frequency for those who underwent surgery (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), while not at any frequency for those who were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Isolated malleus fractures may occur more often than historical data suggests, and are perhaps underdiagnosed. Abrupt removal of a finger from the EAC with pain and hearing loss is nearly pathognomonic. Conductive hearing loss with ABG greater at higher frequencies is most often observed. Observation is unlikely to produce spontaneous improvements in hearing, while surgery demonstrates reliable decreases in ABG. <jats:italic>Laryngoscope<\/jats:italic>, 134:1032\u20131041, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30962","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T05:40:52Z","timestamp":1692423652000},"page":"1032-1041","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Isolated Fracture of the Malleus: An Overlooked Cause of Conductive Hearing Loss?"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8923-6527","authenticated-orcid":false,"given":"Benjamin D.","family":"Lovin","sequence":"first","affiliation":[{"name":"Bobby R. Alford Department of Otolaryngology\u2013Head and Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua Cody","family":"Page","sequence":"additional","affiliation":[{"name":"Bobby R. Alford Department of Otolaryngology\u2013Head and Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2501-8242","authenticated-orcid":false,"given":"Eric N.","family":"Appelbaum","sequence":"additional","affiliation":[{"name":"Wellstar Otology  Marietta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7998-6949","authenticated-orcid":false,"given":"Daniel","family":"Gorelik","sequence":"additional","affiliation":[{"name":"Houston Methodist ENT Specialists  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenny F.","family":"Lin","sequence":"additional","affiliation":[{"name":"Houston Methodist ENT Specialists  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey T.","family":"Vrabec","sequence":"additional","affiliation":[{"name":"Houston Methodist ENT Specialists  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,16]]},"reference":[{"issue":"11","key":"e_1_2_7_2_1","first-page":"531","article-title":"Fracture of the malleus","volume":"28","author":"Keller AP","year":"1949","journal-title":"Eye Ear Nose Throat Mon"},{"key":"e_1_2_7_3_1","first-page":"780","article-title":"Memoire sur les sequestres osseux observes dans les diverses parties de l'appareil auditif","volume":"50","author":"Meniere P","year":"1857","journal-title":"Vingt\u2010Septieme Annee, 3rd Serie, Tome Douzieme, Gaz Med Paris"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-192505000-00001"},{"key":"e_1_2_7_5_1","first-page":"91","article-title":"Ununited fracture of the long process of the malleus","author":"Weir R","year":"1870","journal-title":"Trans Am Otol Soc"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198506000-00006"},{"issue":"1","key":"e_1_2_7_7_1","first-page":"19","article-title":"Malleus\u2010handle fracture: historical review and three new cases","volume":"20","author":"Iurato S","year":"1999","journal-title":"Am J Otol"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_7_9_1","unstructured":"The University of Oxford. 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[Unpublished PhD thesis Umea University]. 2019."}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.30962","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T12:34:43Z","timestamp":1708086883000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.30962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,16]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/lary.30962"],"URL":"https:\/\/doi.org\/10.1002\/lary.30962","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"type":"print","value":"0023-852X"},{"type":"electronic","value":"1531-4995"}],"subject":[],"published":{"date-parts":[[2023,8,16]]},"assertion":[{"value":"2023-04-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}