Otologic Trauma

Otologic Trauma is a topic covered in the 5-Minute Emergency Consult.

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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
    • 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 cavity – injury to cavity may cause peripheral nerve paralysis

Etiology

  • Blunt trauma: Most commonly motor vehicle crashes or fights/contact sports (wrestling, boxing)
  • Penetrating trauma such as tympanic membrane (TM) perforation from cotton swabs or bobby pins
  • Human or animal bites
  • Blast injury
  • Lightning injury: TM and ossicular disruptions occur in 50% of lightning strikes
  • Chemical exposure
  • Thermal injury
  • Diving injuries:
    • Inner-ear barotrauma
    • TM rupture

Pediatric Considerations
Consider nonaccidental trauma

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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
    • 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 cavity – injury to cavity may cause peripheral nerve paralysis

Etiology

  • Blunt trauma: Most commonly motor vehicle crashes or fights/contact sports (wrestling, boxing)
  • Penetrating trauma such as tympanic membrane (TM) perforation from cotton swabs or bobby pins
  • Human or animal bites
  • Blast injury
  • Lightning injury: TM and ossicular disruptions occur in 50% of lightning strikes
  • Chemical exposure
  • Thermal injury
  • Diving injuries:
    • Inner-ear barotrauma
    • TM rupture

Pediatric Considerations
Consider nonaccidental trauma

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