Ear injuries
Ear injuries represent a large category of injuries related to the organs of hearing. It combines injuries:
outer ear (auricle);
middle ear;
the inner ear.
The content of the article:
External ear injuries
Injuries of the inner ear
Middle ear injuries
Ear injuries
These are quite common injuries caused, on the one hand, by poor ear protection from an anatomical point of view, and, on the other, by the traumatism and aggressiveness of the modern lifestyle. Their danger lies in the risk of violation or complete loss of auditory function.
Ear injuries can be classified in different ways. By the type of damage it can be:
blunt injuries (bruises);
wounds (stabbed, cut, torn);
thermal burns;
chemical burns;
frostbite;
ingestion of a foreign body into the ear cavity;
barotrauma (caused by pressure drop);
acoustic injuries (caused by exposure to super-strong sound);
vibration injuries (caused by strong vibrations emanating from complex mechanisms in production conditions);
actinotrauma (caused by exposure to radiant energy).
Injuries to the middle and inner ear are considered more severe than injuries to the auricle, since they are often accompanied by other serious injuries, most often a fracture of the cranial bones or a traumatic brain injury.
Injuries to the middle and inner ear often occur simultaneously. They can be:
straight, applied with pointed objects that fall into the ear canal;
indirect, caused by a pressure drop or a blow to the head.
When making a diagnosis, the circumstances of injury are extremely important, and the treatment of ear injuries should take into account many individual characteristics of the patient.
Each of these three types of injuries has its own symptoms and involves specific diagnostic measures. Accordingly, various ear injuries also require different treatment.
External ear injuries
This species is most common. It includes the following types of damage:
mechanical: their causes are blows, wounds, bites;
thermal: it can be both burns and frostbite;
chemical: caustic substances can get into the ear in laboratories or in production under extreme conditions.
With a strong mechanical impact on the outer ear, there is a risk of damage to the cartilage of the auricle. This, in turn, leads to its partial or complete separation. In addition, a bruise often entails the formation of a hematoma or accumulation of blood under the outer connective layer of cartilage. This is fraught with complications such as:
loss of ear shape and healthy coloring;
getting infected;
suppuration;
tissue death.
The ear can become either a shapeless mass of red color, or a substance resembling cauliflower.
Symptoms of external ear injury:
With blunt trauma:
redness;
edema;
cartilage deformation;
it is possible to develop a hematoma.
In case of injury:
visually accessible wound;
hearing impairment;
bleeding;
blood clots in the external auditory canal;
deformation of the auricle.
With frostbite:
at the first stage — pallor of the skin;
at the second stage — redness of the skin;
with complete frostbite, the skin does not turn red.
In case of burn:
redness;
exfoliation of the upper layers of the skin;
the appearance of blisters;
charring (with severe burns);
the limitation of the lesion (in case of chemical burn).
Any of the above ear injuries is accompanied by his pain. Violation of auditory function occurs with edema of the external auditory canal.
By the way, the external auditory canal itself is injured less often, but it can suffer under a number of conditions:
ingestion of a foreign body;
a blow with a hit to the external auditory orifice;
shrapnel wound;
bullet wound;
burn with hot liquid, steam or caustic chemical.
The bony part of the auditory canal (more precisely, its anterior wall) may be broken as a result of a strong blow to the lower jaw area.
For the diagnosis of external ear injuries, as a rule, a visual examination is sufficient. More detailed studies may be required to rule out the spread of the injury to the auditory canal or nearby organs. To do this, the following procedures are carried out:
otoscopy or microtoscopy;
hearing check;
radiography of the mandibular joint;
radiography of the temporal region;
study of vestibular function.
Endoscopy is usually performed in case of damage to the ear canal. This method allows you to establish the presence of a foreign body in the ear cavity or the formation of blood clots in it. If the cartilage and the walls of the ear are damaged, it is advisable to use a button probe. If an ear injury is accompanied by a concussion, a neurologist’s consultation is mandatory.
First aid in case of an injury to the outer ear is possible only in the case of a shallow wound. A scratch or cut should be treated with an antiseptic:
alcohol solution of iodine;
zelenka;
hydrogen peroxide.
After that, a tight sterile bandage should be applied to the damaged area.
If an ear is bruised, you should immediately consult a doctor, since there is a risk of developing a hematoma, and its accidental opening leads to infection in the auditory canal or inflammation of the cartilage.
Deep wounds require surgical care, including suturing. When the auricle is detached, there is a chance of its preservation, however, important conditions must be met for this:
wrap the organ with a moist clean (or preferably sterile) cloth and place it in an ice jar;
sew on the torn shell within eight hours.
Fracture of the bones surrounding the external auditory canal leads to its narrowing, and recovery is carried out by surgery under general anesthesia.
Injuries of the inner ear
These ear injuries are the most dangerous, since they are often accompanied by damage to the skull (usually its base). There are usually two types of fractures of the base of the skull:
Transverse crack. In this case, the eardrum may suffer greatly, which will lead to serious hearing disorders, up to absolute deafness. In addition, with transverse cracks in the base of the skull, cerebrospinal fluid (cerebrospinal fluid) can flow through the auditory canal.
Longitudinal crack. It appears, as a rule, close to the wall of the eardrum, as a result of which the latter is prone to hemorrhage. If the drum part of the facial canal is touched, then the motor functions of the facial muscles are disrupted. At the same time, the vestibular function practically does not suffer. The rupture of the tympanic membrane accompanying the longitudinal crack manifests itself as bloody discharge from the external auditory canal.
It is worth noting that longitudinal cracks have a more favorable prognosis compared to transverse cracks, which entail a number of irreversible consequences. Among them:
facial paresis;
facial muscle paralysis;
violation of vestibular function;
“vestibular attack” on the intermediate nerve, disrupting the work of taste receptors.
In any case, the symptoms of a traumatic brain injury can overshadow the signs of damage to the inner ear. Usually the victim feels:
tinnitus (on one side or both sides);
dizziness (often very intense);
rotation of surrounding objects;
sensorineural hearing loss (hearing loss);
nausea;
nystagmus.
With a general severe condition, it is difficult to detect a violation of auditory function in the first days.
Separately, it is worth considering injuries to the inner ear caused by aggressive acoustic influences. They come in two types:
sharp;
chronic.
A super-strong sound acting on the human ear, even for a short period of time, can cause acute trauma characterized by hemorrhage. Because of this, there are violations of auditory function, but when the hematoma resolves, hearing returns to normal.
As for chronic acoustic injuries, they occur with long-term exposure to super-strong sound (usually in industrial conditions). The auditory receptors are constantly in a state of overwork, and a person develops hearing loss.
Thermal injury to the ear caused by exposure to hot water or steam, as well as chemical damage can lead to complete destruction of the eardrum, but in practice this is rare. Usually the case is limited to its rupture or hemorrhages due to vascular damage.
Injury to the inner ear occurs when using pointed objects in an attempt to clear the ear canal. Sometimes his injury is the result of a medical error — with careless surgical manipulations with the middle ear.
The main diagnostic method for damage to the inner ear is tomography (computer or magnetic resonance). Assessment of vestibular function can be carried out only with a relatively stable condition of the victim.
Natural recovery is possible only if we are not talking about a traumatic brain injury (for example, with acoustic trauma). Otherwise, hospitalization is inevitable, and most often — in the department of neurology or even neurosurgery. In this case, the treatment takes place with the participation of an otolaryngologist.
An operation that restores the normal anatomical structures of the inner ear is possible only if the patient is in a stable condition. As for the restoration of the victim’s auditory capabilities, in most cases it is impossible to do without hearing replacement.
Middle ear injuries
Injuries of the middle ear in its pure form are rare: more often they are considered in combination with damage to the inner ear. The most common type of injury to the middle ear is a barotrauma caused by a sharp pressure drop outside and inside the eardrum. Its causes may be the following actions:
immersion in water;
take-off by plane;
climbing the mountains;
a kiss on the ear.
Often, the effects of barotrauma are eliminated by the so—called “purging” – several strong exhalations with the mouth closed and the nose clamped. Such an action restores normal pressure in the ear, but it is forbidden to do it to people with the flu or SARS, since pathogens can get into the Eustachian tube when “blowing”.
Complicating the situation with barotrauma is a violation in the work of the Eustachian tube itself. As a result, we can expect the development of aerotitis, which, by the way, is considered an occupational disease of pilots. This kind of inflammation leads to hearing loss, causes vestibular disorders and pain.
Other types of middle ear injuries:
concussion of the eardrum;
rupture of the eardrum;
penetrating wound.
It is worth noting that the rupture of the eardrum may occur as a result of a strong pressure drop, or in the absence of first aid for mild barotrauma.
If the middle ear becomes infected due to damage, acute otitis media develops.
The main symptoms of middle ear injury:
hearing impairment;
spontaneous movements of the eyeballs (nystagmus);
violation of vestibular function;
dizziness;
noise in the ear;
bleeding;
discharge of pus (sometimes).
Diagnostic measures in this case consist, first of all, of an endoscopic examination, which determines:
the fact of damage to the middle ear;
presence or absence of eardrum injury;
the presence or absence of pus in the external auditory canal;
signs of purulent otitis media.
Next, it is necessary to conduct hearing research:
audiometry (assessment of hearing acuity);
threshold audiometry (assessment of the function of the auditory analyzer);
a test with a tuning fork (assessment of the perception of individual tones).
In the presence of an injury to the middle ear, all of them will show a hearing loss of the conductive type.
In some cases, radiography and tomography of the temporal bone are additionally prescribed to diagnose the consequences of fractures.
Treatment of middle ear injuries directly is not difficult, since the eardrum is prone to active regeneration. The wounds should be carefully treated as soon as possible, and in the next few days the victim should take antibiotics.
The perforation hole normally overgrows in about a month and a half. If this does not happen, then medical intervention is required — from treating the edges of the hole with a cauterizing agent to micro-surgery. It can be both plastic and laser.
Some injuries lead to the development of hemotimpanum (accumulation of blood in the middle ear). Against this background, there is swelling of the auditory tube, for the removal of which it is prescribed to take medications that narrow the vessels. When the swelling subsides, the doctor removes the accumulated blood from the tympanic cavity. Exclusively surgical treatment is prescribed for middle ear injury with damage to the auditory ossicles. An operation may also be required to clear the tympanic cavity of pus.
In case of damage to the middle ear, the auditory function should be under special control. If its restoration is naturally difficult, then hearing replacement is required.
