Summary: The largest of the auditory ossicles, and the one attached to the membrana tympani (TYMPANIC MEMBRANE). Its club-shaped head articulates with the INCUS.

Top Publications

  1. Hausler R, Steinhart U. A new self-fixing and articulated malleus grip stapedectomy prosthesis. Adv Otorhinolaryngol. 2007;65:197-201 pubmed
    A new prosthesis for malleus-grip stapedectomy is presented: the Clip(R) Piston MVP according to Häusler...
  2. Bayazit Y, Ozer E, Kanlikama M, Durmaz T, Yilmaz M. Bone cement ossiculoplasty: incus to stapes versus malleus to stapes cement bridge. Otol Neurotol. 2005;26:364-7 pubmed
    In this study, our purpose was to evaluate results of our experience with bone cement repair of ossicular discontinuity between the incus and stapes and between the malleus and stapes.
  3. Chapla M, Nowacek D, Rommel S, Sadler V. CT scans and 3D reconstructions of Florida manatee (Trichechus manatus latirostris) heads and ear bones. Hear Res. 2007;228:123-35 pubmed
    ..05). Measurements of the ear bones (tympanic, periotic, malleus, incus, and stapes) collected during dissection revealed that the ossicular chain was overly massive for the mass ..
  4. Decraemer W, Khanna S, Funnell W. Malleus vibration mode changes with frequency. Hear Res. 1991;54:305-18 pubmed
    ..The malleus vibration at some frequencies is purely translational, it is rotational at others and mixed at most frequencies...
  5. Sim J, Puria S. Soft tissue morphometry of the malleus-incus complex from micro-CT imaging. J Assoc Res Otolaryngol. 2008;9:5-21 pubmed publisher
    The malleus-incus complex (MIC) is unique to mammalian hearing. To develop a comprehensive biomechanical MIC model for the human middle ear, measurements regarding its anatomical features are a necessity...
  6. Ruf I, Maier W. Topography of the chorda tympani nerve and the tensor tympani muscle in carnivores provides a new synapomorphy for Herpestidae (Carnivora, Mammalia). J Morphol. 2010;271:612-20 pubmed publisher
  7. Kim H, Jung H, Kwak H, Shim K, Hu K, Park H, et al. The discomallear ligament and the anterior ligament of malleus: an anatomic study in human adults and fetuses. Surg Radiol Anat. 2004;26:39-45 pubmed
    According to some reports, movement of the malleus, resulting from anterior hypertension on the discomallear ligament (DML), could produce aural symptoms related with damage to middle ear structures...
  8. Decraemer W, Khanna S. Modelling the malleus vibration as a rigid body motion with one rotational and one translational degree of freedom. Hear Res. 1994;72:1-18 pubmed
    ..The observed motion did not fit pure rotation of the malleus around a fixed axis coinciding with the anterior mallar and posterior incudal ligament as is classically assumed...
  9. Puria S, Steele C. Tympanic-membrane and malleus-incus-complex co-adaptations for high-frequency hearing in mammals. Hear Res. 2010;263:183-90 pubmed publisher
    ..For guinea pig and chinchilla, the fused malleus-incus complex rotates about an anterior-posterior axis, due to the relatively lightweight ossicles and bilateral ..

More Information


  1. Shimizu T, Okamoto K, Majima Y. Osteoma of the malleus: a case report and literature review. Am J Otolaryngol. 2003;24:239-41 pubmed
  2. Bance M, Morris D, Vanwijhe R, Kiefte M, Funnell W. Comparison of the mechanical performance of ossiculoplasty using a prosthetic malleus-to-stapes head with a tympanic membrane-to-stapes head assembly in a human cadaveric middle ear model. Otol Neurotol. 2004;25:903-9 pubmed
    Ossiculoplasty using prosthetic reconstruction with a malleus assembly to the stapes head will result in better transmission of vibrations from the eardrum to the stapes footplate than reconstruction with a tympanic membrane assembly to ..
  3. Pulec J, Deguine C. Spontaneous atticotomy. Ear Nose Throat J. 2004;83:304 pubmed
  4. Amin S, Tucker A. Joint formation in the middle ear: lessons from the mouse and guinea pig. Dev Dyn. 2006;235:1326-33 pubmed
    The malleus, incus and stapes form an ossicle chain in the mammalian middle ear. These ossicles are articulated by joints that link the chain together. In humans and mice, fusion of the ossicles leads to hearing loss...
  5. Dong W, Decraemer W, Olson E. Reverse transmission along the ossicular chain in gerbil. J Assoc Res Otolaryngol. 2012;13:447-59 pubmed publisher
    ..The difference in middle ear transmission in forward and reverse directions is most likely due to the different load impedances-the cochlea in forward transmission and the EC in reverse transmission...
  6. Seidman M, Babu S. A new approach for malleus/incus fixation: no prosthesis necessary. Otol Neurotol. 2004;25:669-73 pubmed
    To describe a novel approach to manage malleus/incus fixation.
  7. Mattsson C, Johansson C, Hellstrom S. Myringosclerosis develops within 9h of myringotomy. ORL J Otorhinolaryngol Relat Spec. 1999;61:31-6 pubmed
    ..The pars flaccida responds promptly with an inflammatory reaction characterized by abundant macrophages. Myringosclerosis develops promptly after myringotomy and its establishment is related to an inflammatory reaction...
  8. Chien W, McKenna M, Rosowski J, Merchant S. Isolated fracture of the manubrium of the malleus. J Laryngol Otol. 2008;122:898-904 pubmed
    To describe a series of five patients with isolated fracture of the manubrium of the malleus.
  9. Gea S, Decraemer W, Funnell W, Funnell R, Dirckx J, Maier H. Tympanic membrane boundary deformations derived from static displacements observed with computerized tomography in human and gerbil. J Assoc Res Otolaryngol. 2010;11:1-17 pubmed publisher
  10. Black B. Neomalleus ossiculoplasty. Otol Neurotol. 2002;23:636-42 pubmed
    ..To evaluate the role of ossiculoplasty techniques using neomalleus struts combined with assembly prostheses, in middle ear reconstruction...
  11. Bledsoe S, Koehler S, Tucci D, Zhou J, Le Prell C, Shore S. Ventral cochlear nucleus responses to contralateral sound are mediated by commissural and olivocochlear pathways. J Neurophysiol. 2009;102:886-900 pubmed publisher
    ..The slow component is likely mediated by the OCB collateral projections to the CN. Commissural neurons that leave the CN via the trapezoid body are an additional source of fast, contralateral excitation...
  12. Martin C, Oletski A, Prades J. Surgery of idiopathic malleus fixation. Otol Neurotol. 2009;30:165-9 pubmed
    To describe and compare 2 different surgical techniques used in treatment of malleus fixation syndrome.
  13. Dalchow C, Dünne A, Sesterhenn A, Teymoortash A, Werner J. Malleostapedotomy: the Marburg experience. Adv Otorhinolaryngol. 2007;65:215-21 pubmed
    The surgical procedure for patients with otosclerosis routinely is incus stapedotomy. In case of otosclerosis with incus necrosis or a bony fixation of the malleus and incus, malleostapedotomy is performed.
  14. Bauer M, Pytel J, Vóna I, Gerlinger I. Combination of ionomer cement and bone graft for ossicular reconstruction. Eur Arch Otorhinolaryngol. 2007;264:1267-73 pubmed
    ..Different individual solutions are described if at least the handle of the malleus is present: restoration of a large defect of the long process of the incus, formation of the incus body and the ..
  15. Mangham C. Long-term impact of incus necrosis on revision stapes surgery: incus versus malleus reconstruction. Otol Neurotol. 2009;30:1145-51 pubmed publisher
    ..To determine the effect of incus necrosis on the success of revision stapes surgery...
  16. Huttenbrink K. The mechanics of the middle-ear at static air pressures: the role of the ossicular joints, the function of the middle-ear muscles and the behaviour of stapedial prostheses. Acta Otolaryngol Suppl. 1988;451:1-35 pubmed
    ..air pressure in the external ear canal ranging from 0 to +/- 400 mmH2O induce an inward-outward movement of the malleus. In the regular middle-ear, the direction of this movement is changed within the ossicular chain into a ..
  17. Ebenezer J, Rupa V. Preoperative predictors of incudal necrosis in chronic suppurative otitis media. Otolaryngol Head Neck Surg. 2010;142:415-20 pubmed publisher
    ..To determine the predictive value of preoperative clinical, audiological, and radiological factors in diagnosing incudal necrosis in patients with tubotympanic chronic suppurative otitis media (CSOM)...
  18. Oktay M, Cureoglu S, Schachern P, Gulbahce E, Paparella M, Hayasi H. Histologic changes in the anterior mallear ligament and the head of the malleus in otosclerosis. Otolaryngol Head Neck Surg. 2006;134:232-5 pubmed
    ..To determine ossicular and anterior mallear ligament (AML) changes in otosclerosis...
  19. Willi U, Bronner G, Narins P. Ossicular differentiation of airborne and seismic stimuli in the Cape golden mole (Chrysochloris asiatica). J Comp Physiol A Neuroethol Sens Neural Behav Physiol. 2006;192:267-77 pubmed
    ..between the middle ear anatomy of the Cape golden mole (Chrysochloris asiatica), which exhibits a club-shaped malleus head, and the Desert golden mole (Eremitalpa granti), with a ball-shaped malleus head, suggests differences in ..
  20. Whyte J, Gonzalez L, Cisneros A, Yus C, Torres A, Sarrat R. Fetal development of the human tympanic ossicular chain articulations. Cells Tissues Organs. 2002;171:241-9 pubmed
    ..To obtain further knowledge on the morphogenesis of the articulations in the tympanic ossicular chain in humans...
  21. Ladak H, Decraemer W, Dirckx J, Funnell W. Response of the cat eardrum to static pressures: mobile versus immobile malleus. J Acoust Soc Am. 2004;116:3008-21 pubmed
    A phase-shift shadow moiré interferometer was used to measure the shape of the cat eardrum with a normal mobile malleus and with an immobile malleus as it was cyclically loaded with static middle-ear pressures up to +/-2.2 kPa...
  22. Xu X, Jiang Z, Ma H, Yan D, Chen X, Xu Y, et al. [The study between temporal bone HRCT and operations in congenital abnormality of external and middle ear]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;27:355-8 pubmed
  23. Kohan D, Sorin A. Revision stapes surgery: the malleus to oval window wire-piston technique. Laryngoscope. 2003;113:1520-4 pubmed
    To determine the effectiveness of the malleus to oval window wire-piston revision stapes surgery technique.
  24. Nandapalan V, Pollak A, Langner A, Fisch U. The anterior and superior malleal ligaments in otosclerosis: a histopathologic observation. Otol Neurotol. 2002;23:854-61 pubmed
  25. Martin C, Timoshenko A, Dumollard J, Tringali S, Peoc h M, Prades J. Malleus head fixation: histopathology revisited. Acta Otolaryngol. 2006;126:353-7 pubmed
    b>Malleus head fixation is a rare but not exceptional pathology. It may be apparently congenital or acquired, and can be associated with stapes fixation...
  26. Mason M, Narins P. Seismic sensitivity in the desert golden mole (Eremitalpa granti): a review. J Comp Psychol. 2002;116:158-63 pubmed
    ..An analysis of middle ear morphology suggests that the massive malleus of the golden mole is adapted toward a form of inertial bone conduction, suitable for the detection of seismic ..
  27. Vercruysse J, De Foer B, Somers T, Casselman J, Offeciers E. Mastoid and epitympanic bony obliteration in pediatric cholesteatoma. Otol Neurotol. 2008;29:953-60 pubmed publisher
    ..The objective of this study was to evaluate the long-term surgical outcome and recurrence rate of this technique in children...
  28. Malafronte G, Filosa B, Cantone E. New macroscopic classification of stapedio-ovalar otosclerosis: a simplified rating for training in stapedotomy. Otol Neurotol. 2008;29:889-92 pubmed publisher
  29. Rosowski J, Lee C. The effect of immobilizing the gerbil's pars flaccida on the middle-ear's response to static pressure. Hear Res. 2002;174:183-95 pubmed
    ..tensa and the coupled malleus to sound, before and after immobilizing the p. flaccida. The results are consistent with a limited role of the p...
  30. Tringali S, Bertholon P, Martin C. [Attical fixation of the malleus head associated with obstruction of the round window niche by a high jugular bulb]. Ann Otolaryngol Chir Cervicofac. 2002;119:341-3 pubmed
    To report the case of a 52 year-old-woman presenting with a left mixed hearing loss. Surgical exploration revealed an attical fixation of the malleus head associated with obliteration of the round window by a high jugular bulb.
  31. Hoth S, Lohaus M, Waldmann B. [Auditory brainstem responses evoked by direct mechanical stimulation of the ossicular chain. Objective preoperative testing of candidates for implantable hearing aids]. HNO. 2003;51:550-7 pubmed
    ..For preoperative testing, malleus vibration audiometry has been described [7]...
  32. De Vos C, Gersdorff M, Gerard J. Prognostic factors in ossiculoplasty. Otol Neurotol. 2007;28:61-7 pubmed
    ..To analyze predictive factors of outcome after ossiculoplasty using a standard ossicular prosthesis system...
  33. Gluth M, Metrailer A, Dornhoffer J, Moore P. Patterns of failure in canal wall down mastoidectomy cavity instability. Otol Neurotol. 2012;33:998-1001 pubmed publisher
    ..To evaluate patterns of failure for canal wall down mastoid cavities requiring surgical revision...
  34. Zhang Z, Chen S, Sun W, Zheng Y. Classification and surgical management of localized attic cholesteatoma: single-institution experience and follow-up. ORL J Otorhinolaryngol Relat Spec. 2010;72:96-100 pubmed publisher
    ..To present an effective system for the evaluation and surgical management of localized attic cholesteatoma, as well as describing the follow-up of patients treated at our institution...
  35. Ye F, Zhao K, Chen B, Gao P, Wang X. [The relationship between ossicular status and conductive hearing loss in cholesteatoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;27:701-3 pubmed
    ..To investigate and analyze the characteristic of destructive ossicular chain and it's impact on air-bone gap (ABG) among patients with cholesteatoma...
  36. de La Rochefoucauld O, Olson E. A sum of simple and complex motions on the eardrum and manubrium in gerbil. Hear Res. 2010;263:9-15 pubmed publisher
    ..The manubrium underwent bending at some stimulus frequencies and therefore its motion was not like a rigid body. It had a complex motion with frequency fine structure that seemed likely to be derived from resonances on the drum-like TM...
  37. Dirckx J, Decraemer W. Human tympanic membrane deformation under static pressure. Hear Res. 1991;51:93-105 pubmed
    ..The comparison with data of TM displacement under dynamic stimuli is discussed...
  38. Gluth M, Cohen M, Friedland P, Dornhoffer J, Atlas M. Malleostapedotomy prosthesis size and shape: key measurements from a temporal bone study. Otol Neurotol. 2012;33:518-22 pubmed publisher
    ..By determining the dimensions of middle ear anatomic relationships pertinent to malleostapedotomy (MS), a simplified, yet optimized scheme for sizing, shaping, and placing a prosthesis can be generated...
  39. Sencimen M, Yalcin B, Dogan N, Varol A, Okcu K, Ozan H, et al. Anatomical and functional aspects of ligaments between the malleus and the temporomandibular joint. Int J Oral Maxillofac Surg. 2008;37:943-7 pubmed publisher
    The aim of this paper is to investigate the anatomical topography and the relationship between the ligaments, malleus and temporomandibular joint (TMJ) and to determine the role of these ligaments on the movement of the malleus...
  40. Whyte J, Cisneros A, Yus C, Obón J, Whyte A, Serrano P, et al. Development of the dynamic structure (force lines) of the middle ear ossicles in human foetuses. Histol Histopathol. 2008;23:1049-60 pubmed publisher
    ..To study the ontogenic development of the organisation of the human middle ear ossicles structure...
  41. Santa Maria P, Atlas M, Ghassemifar R. Chronic tympanic membrane perforation: a better animal model is needed. Wound Repair Regen. 2007;15:450-8 pubmed
    ..These areas include a perforation model in the presence of bacteria and eustachian tube dysfunction. Understanding the molecular and genetic mechanisms of chronic otitis media and potential treatments will also be useful...
  42. Todd N. Helpful and unhelpful parts of the superior petrosal triangle. Otolaryngol Head Neck Surg. 2006;134:966-9 pubmed
    The root of zygoma-head of malleus line may guide to the internal auditory canal, but few anatomic studies address its accuracy.
  43. Palomar Asenjo V, Palomar García V, Fortuny Llanses J, Ruiz Giner A. [Malleostapedotomy in the pathology of the incudomalleolar complex combined with fixation of the stapes]. Acta Otorrinolaringol Esp. 2006;57:161-4 pubmed
    ..This circumstance can turn up in several pathologies and also in revision surgery for otosclerosis...
  44. Todd N. Orientation of the manubrium mallei: inexplicably widely variable. Laryngoscope. 2005;115:1548-52 pubmed
    There is no consensus why the manubrium of the malleus, as viewed clinically through the external ear canal, generally points downward and posteriorly.
  45. Kawano H, Ohhashi M, Nakajima M, Tsuboi Y, Komune S. [Surgery for tympanosclerotic stapes fixation accompanied by malleus fixation at the anterior malleus: report of 2 cases]. Nihon Jibiinkoka Gakkai Kaiho. 2004;107:1011-4 pubmed
    Most tympanosclerotic stapes fixation involves fixation or erosion of the malleus and/or incus...
  46. Mishiro Y, Sakagami M, Kitahara T, Kondoh K, Kubo T. Long-term hearing outcomes after ossiculoplasty in comparison to short-term outcomes. Otol Neurotol. 2008;29:326-9 pubmed
    ..To investigate long-term hearing outcomes after ossiculoplasty...
  47. Nagamine H, Arai M, Manabe M, Kodera K. [Stapes surgery performed for congenital stapes foot plate fixation--comparison of prosthesis fixation to the malleus vs. the incus]. Nihon Jibiinkoka Gakkai Kaiho. 2007;110:470-6 pubmed
    ..The prosthesis was reformed to avoid dislocation and fixed to the handle of the malleus. The surgical results in another 49 ears, the comparator group, in which the prosthesis was fixed to the long ..
  48. al Qudah M, Dawes P. Malleus-stapes assembly: experience with two prostheses. J Laryngol Otol. 2006;120:736-9 pubmed
    ..necessary part of middle-ear surgery, the most common defect being that between an intact, mobile stapes and the malleus handle...
  49. Vincent R, Rovers M, Mistry N, Oates J, Sperling N, Grolman W. Ossiculoplasty in intact stapes and malleus patients: a comparison of PORPs versus TORPs with malleus relocation and Silastic banding techniques. Otol Neurotol. 2011;32:616-25 pubmed publisher
    ..using either partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) with Silastic banding and malleus relocation techniques in cases with malleus and stapes both present and mobile.
  50. Hamid M. More than a 50% canal paresis is needed for the head impulse test to be positive. Otol Neurotol. 2005;26:318-9 pubmed
  51. Takanashi Y, Shibata S, Katori Y, Murakami G, Abe S, Rodríguez Vázquez J, et al. Fetal development of the elastic-fiber-mediated enthesis in the human middle ear. Ann Anat. 2013;195:441-8 pubmed publisher
    ..However, hyaluronan expression was not as strong as in adults. Colocalization between elastic fibers and hyaluronan appeared to be a result of postnatal maturation of the entheses. ..
  52. Martin C, Timoshenko A, Martin C, Bertholon P, Prades J. Malleus removal and total cartilage reinforcement in intact canal wall tympanoplasty for cholesteatoma. Ann Otol Rhinol Laryngol. 2004;113:421-5 pubmed
    ..the morphological and hearing results obtained from intact canal wall cholesteatoma surgery by removing the malleus, reinforcing the whole tympanic membrane with cartilage, and performing an ossiculoplasty with a hydroxyapatite ..
  53. Miller R, Pensak M. The superior petrosal triangle as a constant anatomical landmark for subtemporal middle fossa orientation. Laryngoscope. 2003;113:1327-31 pubmed
    ..We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach...