3 Truma of Ear.pdf

Trauma of the ear Prof. EHAB TAHA YASEEN, FIMS, FRCS Glasgow Head of Department of Surgery Consultant Otolaryngologist  External Ear External ear= pinna & ext. auditory canal Types of trauma: 1.LaceraMons 2.Hematoma 3.Burns 4.Frostbite 5.Bites  Lace...

Trauma of the ear Prof. EHAB TAHA YASEEN, FIMS, FRCS Glasgow Head of Department of Surgery Consultant Otolaryngologist  External Ear External ear= pinna & ext. auditory canal Types of trauma: 1.LaceraMons 2.Hematoma 3.Burns 4.Frostbite 5.Bites  LaceraMons - Simple laceraMons – skin with or without carMlage - Stellate – blunt or crush - Avulsion – tear or separaMon Treatment: - Cleaning - Debridement usuallyby and cartilage Both skin , - Repair skin only or plastic - Dressing surgeon - AnMbioMcs ComplicaMons: - PerichondriMs of the auricle - Necrosis of the carMlage - fibrosis - lost shape  Burns - Acute burns: - Thermal - Chemical - Electrical - Treatment: depends on degree, Mssue loss, debridement, AB, - RadiaMon burns: - Acute, Xrst degree, - Late changes: dryness, Xbrosis, telangiectasia, atrophy, necrosis of skin and carMlages  Frostbite Exposure to subfreezing temp.= disrupMon of endothelial layer, extravasaMon of RBCs, platelet aggregaMon and sludging Ex -Pain, burning, discoloraMon, loss of sensaMon and reduced pliability -Slow rewarming, AB, anMcoagulants, debridement, no pressure dressing Bites Human or animal, commonest site is the lobule -MeMculous cleaning, -Systemic AB is more dangerous Human Bite -Repair and or debridement much Bacteria - contain  laceration so Auricular hematoma → no no bleeding , but swelling _ Type of trauma: blunt dueto hematoma Pathogenesis: - Rupture of blood vessels in the perichondrium. - Blood is collected in the sub-perichondrial space (which is potenMal space) - My leads to destrucMon and Xbrosis of the blood anymore carMlage of the auricle. (Explain that) that - Because supply no → 72hr and cartilage of no dies blood supply ^ after Site: especially on the external aspectunderlying into attachment of the auricle. of skin to the cartilage % external (Explain that) that B- Because which mobility has less mobility the medial aspect. and has easily some to be de attach met - , unlike → collection of hematoma  :Treatment Hw *. É %Ñ f- late or large hematoma B - EvacuaMon of hematoma (aspiraMon vs. incision) - PrevenMon of recurrence: compression by moulded splint. - Consequences of failure of treatment leads to Xbrosis of the clot and carMlage destrucMon (cauli]ower ear).  :¥É eat aspiration cauliflower  Trauma of the middle and inner ear  Fractures of the temporal bones(fractured base of the skull) There are 3 types of fractures involving the temporal bone: 1. Longitudinal fracture: less dangerous More common. - 80% - Pathology: the line of the fracture run along the long axis Part of temporal bone of the petrous bone involving the tympanic cavity, tympanic membrane and the external auditory canal. Clinical features: ✓ - ConducMve deafness usually recovers - Bleeding from the lacerated skin of the canal - Haemotympanum: collecMon of blood in the middle ear with intact TM - The drumhead is black or blue - Facial paralysis may occur - CSF otorrhea is rare and usually of short duraMon. 2. Transverse fracture: less common mere dangerous , - 20% - Pathology: the fracture line runs at right angle to the long *% axis of the petrous bone, may pass anterior or posterior to the labyrinth, someMmes through it, or involve the internal auditory meatus. in very severe trunnel so there's and other injuries. and usually present Unconscious Clinical features: - Sensorineural deafness is usually permanent. - VerMgo and nystagmus usually present Mll compensaMon of the vesMbular loss is happened. - Haemotympanum may occur. More - Facial paralysis is not uncommon can be delayed and incomplete due to compression by edema or complete and immediate due to laceraMon. 3. Mixed type, rarest type Treatment: Priority for head injury. AnMbioMcs. Ruptured tympanic membrane: early treatment is conservaMve if failed do myringoplasty Facial palsy if immediate and severe needs exploraMon for reconstrucMon. ConducMve deafness if permanent means ossicular disconnecMon which needs reconstrucMon. TraumaMc rupture of the tympanic membrane AeMology: 1. Trauma by instrumentaMon or ear syringing. 2. Trauma by foreign bodies. 3. Sudden air compression as hand slap or explosion or rapid descent in unpressurized air crac (Barotrauma) 4. Sudden ]uid compression as blow on the ear when the canal is Xlled with water as in diving. É-- & I M- ' - ' I 5. In]aMon of the Eustachian tube. If this is over forceful or the membrane is fragile. gi c. History of " of TM injury perforation " 6. Fractured base of the skull.  AnMbioMcs Enter inside dry.  PrecauMon during bathing - keep it no water  Leave the clots inside do not try to remove it (it is clean and used for future healing)  Never syringe the ear.  Wait for spontaneous healing. If no healing is observed acer 3 months perform myringoplsty (reconstrucMon of the membrane by grac) subtotal TM Perforation no to trainee ☐ to : - Bcuz Recent Bleeding ?? Margins... _ Middle Ear Barotrauma: Éoumacavged by changes Can be caused by: atoms Photic - Descent of airplane - Scuba diving - Blast injury Can causes: depends severity on... - TM retracMon -0 treatment - Middle ear efusion usually medical-0 - Hemotympanum -0 not ? -0 myringoplsty - TM perforaMon conservative 3. months → → fixed - Perilymph Xstula surgery → Management plane nasal decongestants no - PrevenMon if Pt has cold flues -. Restrictions or , with Gum - G- JA Drmkwate ¥ - Treat accordingly  of lecture : Qui 2 at the end Quiz : mention 3 causes that lead to rupture of the tympanic membrane ? #ENT_quiz