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").

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:
   • the fracture line runs through the area of the external auditory canal,l
   • violates the annulus tympanicus, can damage the eardrum and middle ear,
   • goes further to the tip of the pyramid to the foramen lacerum,
   • the inner ear is not usually affected, the facial nerve is rarely affected,
   • main symptom – hemotympanum, perforation of the tympanic membrane, conductive hearing loss, liquorice,
   • there is a risk of ascending infection and meningitis.
2. Transverse type:
   • the refraction line is perpendicular to the long axis of the pyramid,
   • can go through the labyrinth, the middle ear is not affected,
   • involvement of N. VII and N. VIII is common,
   • symptoms – severe dizziness, nausea, vomiting dominates,
     • severe perceptual hearing loss,
   • 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.

Links

Source

• BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2009]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.

Reference

• KLOZAR, Jan. Speciální otorinolaryngologie. 1. edition. Praha : Karolinum, 2005. 224 pp. ISBN 80-246-1125-2.