The document discusses different types of ear trauma, including external, middle, and inner ear injuries. External ear trauma commonly involves blunt trauma to the auricle, which can lead to auricular hematoma or deformity. Middle ear trauma often involves traumatic perforation of the tympanic membrane from injuries like compression or welding burns. Inner ear trauma includes blunt trauma, penetrating injuries, and barotrauma, which can cause temporal bone fractures, hearing loss, dizziness, and CSF leaks. Imaging like CT and MRI is used to evaluate the injuries, while treatment depends on the specific type and severity of trauma.

1. External, middle and inner Ear Traumas:By Catherine KeruboMl 410

2. Externalear traumaThe 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.

3. 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.

4. Post-traumatic auricular hematoma Primarily sutured lacerated ear canal.

5. EtiologyTympanic Membrane is much more traumatized than the Inner Ear 1.4 - 8.6 per 100,000 -Men> Women - Children are curious

6. Classification of TM PerforationsQuadrant Size Marginal vs. Central

7. Traumatic TM PerforationsCompression Injuries BarotraumaPenetrating Injuries Thermal Injuries Lightning/Electrical Injuries

8. Traumatic perforation of the tympanic membrane due to welding injury.Otoscopic picture of longitudinal temporal bone fracture

9. Middle Ear TraumaIs usually associated with TM or inner ear trauma unless Iatrogenic Ossiculardiscontinuity Facial Nerve Injury Chorda tympani Nerve Injury Barotraumato Stapes footplate

10. Inner Ear TraumaBlunt Trauma Penetrating Trauma Barotrauma

11. Blunt TraumaTemporal Bone Fractures Longitudinal Transverse Oblique

12. Longitudinal fractures80% of Temporal Bone Fractures Lateral Forces along the petrosquamous suture line 15 20% Facial Nerve involvement 15-EAC laceration

13. Transverse fractures20% of Temporal Bone Fractures Forces in the Antero - Posterior direction50% Facial Nerve Involvement EAC intact

14. Penetrating TraumaIncrease in violence and firearms Associated with more dismal outcome More likely to involve intracranial lesions

15. BarotraumaRapid pressure fluctuations with the inner ear Air travel or SCUBA diving “the bends”

16. Physical ExaminationBasilar Skull Fractures PeriorbitalEcchymosis (Raccoon’s Eyes)

17. Mastoid Ecchymosis (Battle’s Sign)

18. Hemotympanum

19. Tuning Fork exam

20. Pneumatic OtoscopyImagingHRCT MRI Angiography/ MRA

21. SymptomsHearing Loss Dizziness CSF Otorrhea and RhinorrheaFacial Nerve Injuries

22. Hearing LossFormal Audiometry vs. Tuning Fork 71% of patients with Temporal Bone Trauma have hearing loss TM Perforations CHL > 40db suspicious for ossicular discontinuityLongitudinal Fractures Conductive or mixed hearing loss

23. 80% of CHL resolve spontaneously Transverse Fractures Sensorineuralhearing loss

24. Less likely to improveDizzinessOticcapsule fracture, labyrinthine concussion, PerilymphaticFistulaPerilymphatic Fistulas Fluctuating dizziness and/or hearing loss