External, middle and inner ear traumas

5,273 views

Published on

External, middle and inner ear traumas

  1. 1. External, middle and inner Ear Traumas:<br />By Catherine Kerubo<br />Ml 410<br />
  2. 2. Externalear trauma<br />The external ear, consisting of the auricle and external auditory canal (EAC), is<br /> generally more vulnerable to physical trauma. <br />The auricle is very vulnerable<br /> to both blunt and sharp trauma. <br />
  3. 3. The most common complication from<br /> blunt trauma to the ear is the formation of auricular hematoma. <br />Failureto recognize and treat this condition early usually leads to an ugly deformity<br /> of the pinna known as a “cauliflower” ear.<br />
  4. 4. Post-traumatic auricular hematoma<br /> Primarily sutured lacerated ear canal.<br />
  5. 5. Etiology<br />Tympanic Membrane is much more traumatized than the Inner Ear <br />1.4 - 8.6 per 100,000 <br /> -Men> Women <br /> - Children are curious<br />
  6. 6. Classification of TM Perforations<br />Quadrant <br />Size <br />Marginal vs. Central<br />
  7. 7. Traumatic TM Perforations<br />Compression Injuries <br />Barotrauma<br />Penetrating Injuries <br />Thermal Injuries <br />Lightning/Electrical Injuries <br />
  8. 8. Traumatic perforation of the tympanic membrane due to welding injury.<br />Otoscopic picture of longitudinal temporal bone fracture<br />
  9. 9. Middle Ear Trauma<br />Is usually associated with TM or inner ear trauma unless Iatrogenic <br />Ossiculardiscontinuity <br />Facial Nerve Injury <br />Chorda tympani Nerve Injury <br />Barotraumato Stapes footplate <br />
  10. 10. Inner Ear Trauma<br />Blunt Trauma <br />Penetrating Trauma <br />Barotrauma<br />
  11. 11. Blunt Trauma<br />Temporal Bone Fractures <br />Longitudinal <br />Transverse <br />Oblique<br />
  12. 12. Longitudinal fractures<br />80% of Temporal Bone Fractures <br />Lateral Forces along the petrosquamous suture line <br />15 20% Facial Nerve involvement 15-<br />EAC laceration<br />
  13. 13. Transverse fractures<br />20% of Temporal Bone Fractures <br />Forces in the Antero - Posterior direction<br />50% Facial Nerve Involvement <br />EAC intact<br />
  14. 14. Penetrating Trauma<br />Increase in violence and firearms <br />Associated with more dismal outcome <br />More likely to involve intracranial lesions<br />
  15. 15. Barotrauma<br />Rapid pressure fluctuations with the inner ear <br />Air travel or SCUBA diving <br />“the bends”<br />
  16. 16. Physical Examination<br />Basilar Skull Fractures <br /><ul><li>PeriorbitalEcchymosis (Raccoon’s Eyes)
  17. 17. Mastoid Ecchymosis (Battle’s Sign)
  18. 18. Hemotympanum
  19. 19. Tuning Fork exam
  20. 20. Pneumatic Otoscopy</li></li></ul><li>Imaging<br />HRCT <br />MRI <br />Angiography/ MRA <br />
  21. 21. Symptoms<br />Hearing Loss <br />Dizziness <br />CSF Otorrhea and Rhinorrhea<br />Facial Nerve Injuries <br />
  22. 22. Hearing Loss<br />Formal Audiometry vs. Tuning Fork <br />71% of patients with Temporal Bone Trauma have hearing loss <br />TM Perforations <br /><ul><li>CHL > 40db suspicious for ossicular discontinuity</li></li></ul><li>Longitudinal Fractures <br /><ul><li>Conductive or mixed hearing loss
  23. 23. 80% of CHL resolve spontaneously </li></ul>Transverse Fractures <br /><ul><li>Sensorineuralhearing loss
  24. 24. Less likely to improve</li></li></ul><li>Dizziness<br />Oticcapsule fracture, labyrinthine concussion, PerilymphaticFistula<br />Perilymphatic Fistulas <br /><ul><li>Fluctuating dizziness and/or hearing loss
  25. 25. Tulio’s Phenomenon
  26. 26. Management
  27. 27. 40% spontaneously close
  28. 28. Surgical management</li></li></ul><li>BPPV <br /><ul><li>Acute, latent, and fatigable vertigo
  29. 29. Can occur any time following injury
  30. 30. Dix Hallpike
  31. 31. EpleyManeuver</li></li></ul><li>CSF Otorrhea and Rhinorrhea<br />Temporal bone Fractures are the most common cause of CSF Otorrhea<br />Beta transferrin Beta-2-<br />HRCT<br />
  32. 32. Management <br /><ul><li>Conservative therapy
  33. 33. Antibiotics
  34. 34. Surgery</li>

×