CASE REPORT 146 Indian Journal of Otology | July 2014 | Vol 20 | Issue 3 | IntroductIon Avulsion fracture by defnition is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. Avulsion injury of ossicular chain is not a common clinical entity in otological practice. Ossicular chain injuries are commonly encountered in head trauma following road trafc injury, accidental fall, blast injury, or direct injury. However, a common practice of wax removal in certain parts of rural India and other parts of the world, by using a locally manufactured ear hook or spatula can also be a major cause of ossicular injury although such cases have not ofen been reported in English literature. Types of ossicular injury mentioned in literature are fracture, fracture dislocation, disarticulation, and dislocation; but not avulsion injury. Here, we present one such case of avulsion injury of malleoincudal complex without fracture, but with dislocation into the inferior mesotympanum with severe conductive Avulsion of malleoincudal complex with dislocation: A rare ossicular chain injury by using an indigenous claw-like ear hook with review of literature Produl Hazarika, Seema Elina Punnoose, John Victor, Rajeev Chaturvedi 1 Departments of Ear, Nose and Throat, 1 Radiology, NMC Specialty Hospital, Abu Dhabi, U.A.E deafness inficted by a locally manufactured ear hook in adults. Such injuries are difcult to manage in a primary care center setting, and hence, could be prevented by increasing patient awareness and by performing reconstructive surgery whenever possible to overcome the conductive deafness. casE rEPort wIth rEVIEw Mr, S KSK, a 30‑year‑old young Indian, male patient visited the Ear, Nose, and Troat (ENT) Clinic of NMC Specialty Hospital, Abu Dhabi on 13 th  September 2013 for complaints of sudden lef‑sided ear blocking, hearing loss, and tinnitus which happened 4 months ago following insertion of an ear hook by his 5‑year‑old son. Tis is a specially designed ear Direct ear trauma through external auditory canal causing an avulsion injury of malleoincudal complex is a grievous injury that can happen during ear cleaning with indigenous ear hook. One such case of avulsion injury is presented here with its symptomatology, investigation, and management with the review of available literature because of its rarity. Various locally designed indigenous ear hooks are available in street side markets and even online for purchase and used by many without knowing its ill effects on health. Injury caused by these types of hooks may lead to a severe hearing disability, if not properly treated. This presentation is to highlight the fact that indigenous ear hooks; rampantly available online for purchase can cause a potentially major injury leading to hearing disability and thereafter poor quality of life. Reporting and highlighting of such incidents among the ENT community can help increase the public awareness; thereby, eliminating such disastrous consequences. Wikipedia, PubMed, and Google search engine has been used for our data collection and analysis. KEywords: Avulsion injury, Indigenous claw hook, Malleoincudal complex, Partial ossicular replacement prosthesis, Sheehy’s abstract Address for correspondence: Dr. Produl Hazarika, Department of Ear, Nose, and Throat, P. O. Box 6222, NMC Specialty Hospital, Abu Dhabi, U.A.E. E‑mail: produl_ent@rediffmail.com Access this article online Quick Response Code: Website: www.indianjotol.org DOI: 10.4103/0971-7749.136881