Ear Injury

External Ear Injuries
Injuries are divided into open and closed:
 * 1) open – tearing, cutting or biting,
 * 2) closed – created by a blunt blow:
 * othaematoma auriculae occurs most often
 * the basis is a blood effusion between the cartilage and the perichondrium – bluish-red swelling with fluctuation, changes the shape of the auricle,
 * can fester → abscess or absces či perichondritis,
 * can organize → ligament forms → pernament cartilage deformity ("boxer´s ear").

Treatment

 * Open ones are sutured, in case of cartilage injury - resection and then suture,
 * smaller othematomas – compression, larger ones – puncture, they are drained, drenují se,
 * ATB cover is suitable

Injury to the Ear Canal

 * independently or in more complicated traumas,
 * open wounds - often accidentally when cleaning the ear canal,
 * middle ear injury must be ruled our,
 * blunt trauma - swelling or hemorrhagic blister
 * injury to the bony part - part of the temporal bone fractures - typically a stair deformity with lost lumina occurs,
 * treat open wounds with antiseptics, drain larger subepidermal hematomas,
 * the result can be fibrous stenosis - a surgical solution.

Perforation of the Eardrum

 * directly – when cleaning the ear, during injuries,
 * indirectly – by a sudden increase in pressure (barotrauma, acoustic trauma, blow with the surface of the palm),
 * it can be part of a larger injury (middle ear, fractures…).

Symptoms

 * pain, bleeding from the ear canal, conductive hearing loss (depends on the size),
 * otoscopically - perforation of various sizes with uneven bloody edges,
 * in case of secondary infection, pus flows out,
 * the discharge of clear fluid raises the suspicion of cerebrospinal fluid or perilymphatic fluid leakage.

Therapy
If a perforation of the eardrum is suspected, we do not rinse the ear canal!
 * careful cleaning,
 * adapt the edges of the perforation, or cover the perforation with paper (prevents dirt from entering),
 * uninfected, centrally located tend to heal spontaneously (several weeks),
 * at worst surgery – myringoplasty.

Middle Ear Injuries

 * mechanisms are similar to the drum,
 * indirect damage can also occur behind an intact eardrum,
 * as a rule, the injury is accompanied by an effusion of blood into the middle ear - hemotympanum,
 * the chain of auditory ossicles can be broken (most often between the anvil and the stirrup),
 * the stirrup can be torn out of the oval window,
 * the facial nerve and inner ear may be affected.

Symptoms

 * pain, bleeding from the ear canal, hearing impairment;
 * conductive hearing loss, when there is also a perceptual component, the inner ear is also affected;
 * when the eardrum is intact - on otoscopy - blue-red coloration behind the eardrum.

Therapy

 * simple hematympanon - no need to intervene, it resorbs spontaneously (possibly ATB),
 * we remove foreign bodies,
 * disruption of bones - surgical reconstruction.

Inner Ear Injuries
(Labyrinth shock, coma)
 * most often as part of larger skull injuries,
 * there will be a violation of the micromechanical structure of the membranous membranous system,
 * e. g. breach of the barrier between endo and perilymph, bleeding into the labyrinth,
 * we usually cannot diagnose the cause.

Symptoms

 * functional disabilities of varying extent (impairment of balance functions, perceptual hearing impairment, possibly both...),,
 * hearing usually improves within 2 weeks, dizziness lasts longer,
 * acute symptoms are usually covered by symptoms of cerebral coma or brain contusion.

Acoustic Drama

 * acute ear damage from sound,
 * in isolation, the inner ear is mainly affected by a bang that lasts a shorter time (shot)
 * during the explosion, the middle ear is still damaged by the pressure,
 * functional loss is most often in the area of the basal turn of the cochlea (typical hearing loss with a maximum around 4 kHz).

Symptoms

 * hearing loss to deafness, often also tinnitus,
 * vestibular apparatus disorder - dizziness with nystagmus,

Therapy

 * the influence of the treatment on the condition has not yet been unequivocally proven.

Fractures of the temporal bone and the laterobasal injuries

 * 1) Longitudinal type:
 * 2) * the fracture line runs through the area of the external auditory canal,l
 * 3) * violates the annulus tympanicus, can damage the eardrum and middle ear,
 * 4) * goes further to the tip of the pyramid to the foramen lacerum,
 * 5) * the inner ear is not usually affected, the facial nerve is rarely affected,
 * 6) * main symptom – hemotympanum, perforation of the tympanic membrane, conductive hearing loss, liquorice,
 * 7) * there is a risk of ascending infection and meningitis.
 * 8) Transverse type:
 * 9) * the refraction line is perpendicular to the long axis of the pyramid,
 * 10) * can go through the labyrinth, the middle ear is not affected,
 * 11) * involvement of N. VII and N. VIII is common,
 * 12) * symptoms – severe dizziness, nausea, vomiting dominates,
 * 13) ** severe perceptual hearing loss,
 * 14) * the balance is compensated centrally within a few days, the hearing impairment remains,
 * therapy – mostly conservative - cover the ear canal sterilely, ATB prophylaxis.

Inflammation of the Middle Ear (Otitis Media)

 * we have either catarrhal (non-purulent) or purulent inflammations,
 * each is either acute or chronic,
 * purulent chronic is either mesotympanic or epitympanic.