Otologic Trauma

Basics

Description

Pinna

  • Ear cartilage has no blood supply and is nutritionally dependent on perichondrium
  • Hematomas often disrupt perichondrium and cartilage that can lead to:
    • Ischemia
    • Perichondritis
    • Necrosis
    • Also known as: cauliflower ear
  • Penetrating injuries or bite wounds may lead to infection of cartilage

Middle Ear

  • Air-space cavity containing ossicles; susceptible to injuries disrupting middle-ear pressure (blast, diving)
  • Bordered by medial cranial fossa (including temporal and mastoid bones)
  • Traumatic fractures can lead to CSF leak (otorrhea/rhinorrhea) and may disrupt enclosed vestibular system:
    • Facial nerve passes through the facial canal within the temporal bone, coursing adjacent to the middle ear cavity, where injury can result in peripheral nerve paralysis.

Etiology

  • Blunt trauma: Most commonly motor vehicle crashes or fights/contact sports (wrestling, boxing):
    • Otologic involvement noted in about ¼ of patients with head injury
  • Foreign bodies (FBs): Objects vary by age; toy-related objects including marbles and air-gun pellets are more likely in children under 10 yr old. As age increases, toys became a smaller proportion, while cotton balls, insects, and earring materials became more common:
    • Complications include laceration and tympanic membrane (TM) perforation
  • Human or animal bites
  • Blast injury
  • Lightning injury: TM and ossicular disruptions occur in 50% of lightning strikes
  • Fireworks injury: 15% are otologic injuries including hearing loss, otalgia, and TM perforation
  • Chemical exposure
  • Thermal injury
  • Diving injuries:
    • Inner-ear barotrauma
    • TM rupture

Pediatric Considerations

Consider nonaccidental trauma

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