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External, middle and inner ear traumas
 

External, middle and inner ear traumas

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    External, middle and inner ear traumas External, middle and inner ear traumas Presentation Transcript

    • External, middle and inner Ear Traumas:
      By Catherine Kerubo
      Ml 410
    • Externalear trauma
      The external ear, consisting of the auricle and external auditory canal (EAC), is
      generally more vulnerable to physical trauma.
      The auricle is very vulnerable
      to both blunt and sharp trauma.
    • The most common complication from
      blunt trauma to the ear is the formation of auricular hematoma.
      Failureto recognize and treat this condition early usually leads to an ugly deformity
      of the pinna known as a “cauliflower” ear.
    • Post-traumatic auricular hematoma
      Primarily sutured lacerated ear canal.
    • Etiology
      Tympanic Membrane is much more traumatized than the Inner Ear
      1.4 - 8.6 per 100,000
      -Men> Women
      - Children are curious
    • Classification of TM Perforations
      Quadrant
      Size
      Marginal vs. Central
    • Traumatic TM Perforations
      Compression Injuries
      Barotrauma
      Penetrating Injuries
      Thermal Injuries
      Lightning/Electrical Injuries
    • Traumatic perforation of the tympanic membrane due to welding injury.
      Otoscopic picture of longitudinal temporal bone fracture
    • Middle Ear Trauma
      Is usually associated with TM or inner ear trauma unless Iatrogenic
      Ossiculardiscontinuity
      Facial Nerve Injury
      Chorda tympani Nerve Injury
      Barotraumato Stapes footplate
    • Inner Ear Trauma
      Blunt Trauma
      Penetrating Trauma
      Barotrauma
    • Blunt Trauma
      Temporal Bone Fractures
      Longitudinal
      Transverse
      Oblique
    • Longitudinal fractures
      80% of Temporal Bone Fractures
      Lateral Forces along the petrosquamous suture line
      15 20% Facial Nerve involvement 15-
      EAC laceration
    • Transverse fractures
      20% of Temporal Bone Fractures
      Forces in the Antero - Posterior direction
      50% Facial Nerve Involvement
      EAC intact
    • Penetrating Trauma
      Increase in violence and firearms
      Associated with more dismal outcome
      More likely to involve intracranial lesions
    • Barotrauma
      Rapid pressure fluctuations with the inner ear
      Air travel or SCUBA diving
      “the bends”
    • Physical Examination
      Basilar Skull Fractures
      • PeriorbitalEcchymosis (Raccoon’s Eyes)
      • Mastoid Ecchymosis (Battle’s Sign)
      • Hemotympanum
      • Tuning Fork exam
      • Pneumatic Otoscopy
    • Imaging
      HRCT
      MRI
      Angiography/ MRA
    • Symptoms
      Hearing Loss
      Dizziness
      CSF Otorrhea and Rhinorrhea
      Facial Nerve Injuries
    • Hearing Loss
      Formal Audiometry vs. Tuning Fork
      71% of patients with Temporal Bone Trauma have hearing loss
      TM Perforations
      • CHL > 40db suspicious for ossicular discontinuity
    • Longitudinal Fractures
      • Conductive or mixed hearing loss
      • 80% of CHL resolve spontaneously
      Transverse Fractures
      • Sensorineuralhearing loss
      • Less likely to improve
    • Dizziness
      Oticcapsule fracture, labyrinthine concussion, PerilymphaticFistula
      Perilymphatic Fistulas
      • Fluctuating dizziness and/or hearing loss
      • Tulio’s Phenomenon
      • Management
      • 40% spontaneously close
      • Surgical management
    • BPPV
      • Acute, latent, and fatigable vertigo
      • Can occur any time following injury
      • Dix Hallpike
      • EpleyManeuver
    • CSF Otorrhea and Rhinorrhea
      Temporal bone Fractures are the most common cause of CSF Otorrhea
      Beta transferrin Beta-2-
      HRCT
    • Management
      • Conservative therapy
      • Antibiotics
      • Surgery