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Mechanical damage to the ear
From a hematoma. A hematoma is a hemorrhage between the cartilage and perichondrium of the auricle or, sometimes, between the perichondrium and the skin. The causes of othematoma are injuries of the auricle in wrestlers, boxers, people with heavy physical labor, with prolonged pressure of a hard pillow or other item placed under the head, especially in people with impaired blood circulation, mainly in the elderly and depleted. Even a slight tangential trauma to the auricle can cause hematoma. It has the appearance of a hemispherical smooth swelling on the front surface of the auricle, purple, painful, fluctuating.
Treatment. A small hematoma can dissolve on its own or after lubricating it with an alcoholic solution of iodine and applying a pressure dressing. In the absence of a reverse development of the hematoma, it is punctured, the contents are aspirated, a few drops of 5% alcohol solution of iodine are introduced, a pressure dressing or collodion film is applied. When indicated, punctures are repeated. If they are unsuccessful, then the hematoma is opened and drained. With suppuration, the development of chondroperichondritis, incisions are made with curettage of granulations, dead tissue, washed with antibiotics, drained and a pressure bandage is applied. Antibiotics are prescribed parenterally, taking into account the sensitivity of flora to them. In case of cartilage fractures, fragments are adjusted and a modeling pressure bandage is applied.
Damage to the auricle. Superficial damage to the auricle occurs with bruises, bumps, cuts, insect bites. There is a partial or complete separation of the auricle. Wound infection can lead to perichondritis and disfiguring scars.
Treatment. They make a toilet of the skin around the wound with alcohol, 5% tincture of iodine, apply primary cosmetic sutures under local anesthesia, an aseptic dressing. Introduce subcutaneously tetanus toxoid. Intramuscular antibiotics or sulfa drugs are prescribed. In the absence of suppuration, the wound heals by first intention. In such cases, dressing with removal of sutures is performed in a week. When suppuration of the wound, the sutures are removed after a few days and treated according to the rules of purulent surgery (dressings with furacilin, Vishnevsky ointment or hypertonic sodium chloride solution). Healing takes place by secondary intention.
For deep (punctured and incised) wounds, detachments of the auricles, initial surgical treatment is performed, foreign bodies are removed, non-viable tissues and the wound are sutured. Novocainic anesthesia is performed with penicillin. To determine the nature and extent of the damage, X-ray of the temporal bones, skull, otoscopy, a hearing test using speech and tuning forks (quality tests), spontaneous vestibular reactions (dizziness, nystagmus, deviation of the arms, disturbances in static and dynamic balance) are performed.
Damage to the external auditory canal. Injuries to the membranous part of the auditory canal are often combined with damage to the auricle or occur in isolation when removing a foreign body, sulfur plug, ear toilet. Damage to the bony walls of the ear canal is often combined with injuries of the zygomatic and mastoid processes, mandibular joint, tympanic cavity, and sometimes with damage to the inner ear.
Indirect damage to the bony part of the ear canal is more common. They are observed when striking the lower jaw, when there is a fracture of the anterior lower wall of the ear canal, which is accompanied by bleeding from the ear and pain during movements of the lower jaw.
The diagnosis is made on the basis of examination of the wound, sounding, otoscopy, radiography of the temporal bones and mandibular joint, as well as studies of hearing and vestibular function.
Treatment. Wound toilet with flushing with furatsilin, primary surgical treatment, sterile turundas or with liquid paraffin, synthomycin emulsion in the ear canal. Administration of tetanus toxoid (0.5 ml subcutaneously). During dressings, 10 drops of hydrocortisone emulsion are injected into the ear canal. With a tendency to atresia, a polyvinyl tubular dilator is inserted into the ear canal. Prescribe antibiotics, ultraviolet ultraviolet radiation, UHF and microwave. In case of fractures of the anteroposterior wall of the ear canal, liquid food is prescribed, the lower jaw is fixed with a bandage.
Damage to the eardrum occurs with a sudden increase or decrease in pressure in the ear canal due to hermetic closure during an impact on the ear, falling on it, playing snowballs, diving, kissing, violating the rules of compression and decompression in divers, caissons, and acubarotrauma from explosion and in the treatment of patients in a pressure chamber. The integrity of the tympanic membrane can be violated during fractures of the base of the skull, pyramid of the temporal bone.
There is a sharp pain in the ear, noise and hearing loss. When scanned, hemorrhages in the tympanic membrane, hematoma in the tympanic cavity, bleeding from the ear and traumatic perforation up to a complete defect of the membrane can be observed. Perforation often has scalloped edges.
Treatment. With spotting in the ear canal, the doctor carefully makes a dry ear toilet using a cotton pad or aspirator to view the eardrum. Then, sterile dry turunda is inserted into the ear canal. Drops in the ear and flushing it are contraindicated due to possible infection. Antibiotics are prescribed intramuscularly to prevent otitis media, and if it develops, then treatment is used as in acute purulent otitis media.
Small traumatic perforations are often replaced spontaneously with scar tissue.
With large fresh dry perforations, it is advisable to stick an egg amnion (film) on the eardrum, along which, as a bridge, can regenerate the epithelium and epidermis, closing the perforation. For chronic perforations, the edges of which are covered with scar tissue, this method can be effective, but only after refreshing the edges. Typically, persistent dry perforations or a complete defect in the tympanic membrane are eliminated in the subsequent, when indicated, using surgery - myringoplasty.
Damage to the auditory ossicles is difficult to assess. They can be combined with a violation of the integrity of the eardrum. There is a fracture of the malleus, anvil, their dislocation, displacement of the base plate of the stirrup, dislocation of it. Such changes also occur with injuries to the skull, lower jaw.
If otoscopy and microscopy do not show damage to the auditory ossicles, then it is very difficult to diagnose, since conductive hearing loss depends on the state of the entire circuit of the sound-conducting apparatus. With an entire tympanic membrane, a break in the auditory ossicle chain can be detected using tympanometry when a tympanogram of type D (hypertensibility of the tympanic membrane) is detected. With perforation of the tympanic membrane and violation of the auditory ossicle chain, the nature of their pathology is most often recognized during surgery - tympanoplasty.
Treatment. Various types of tympanoplasty are produced, depending on the nature of the traumatic injuries of the auditory ossicles and the eardrum to restore sound conduction in the middle ear.
Fractures of the base of the skull are often accompanied by a fracture of the pyramid of the temporal bones. Distinguish between longitudinal and transverse fractures of the temporal bone (Fig. 1.11.1).
A longitudinal fracture is more common. It corresponds to a transverse fracture of the base of the skull. With a longitudinal fracture of the pyramid of the temporal bone, there may be a rupture of the tympanic membrane, since the crack passes through the roof of the tympanic cavity, the upper wall of the external auditory canal. Severe condition, bleeding and cerebrospinal fluid from the ear, hearing impairment are noted. There may be facial paralysis. X-ray of the temporal bones confirms a fracture or crack. Fractures of the base of the skull and pyramid of the temporal bone in the absence of external wounds, but the outflow of cerebrospinal fluid from the ear, are considered open injuries due to the possibility of infection of the cranial cavity.
Transverse fracture. With a transverse fracture of the temporal bone, the eardrum often does not suffer, the crack passes through the massif of the inner ear, therefore auditory and vestibular functions are disturbed and facial paralysis is detected. Bleeding and cerebrospinal fluid from the ear does not happen.
A particular risk of temporal bone fractures is the possible development of intracranial complications (otogenic pachyleptomeningitis and encephalitis) when infection penetrates from the middle and inner ear into the cranial cavity.
Pay attention to the patient’s serious condition, spontaneous vestibular reactions (dizziness, nystagmus, deviation of the hands, disturbance of static and dynamic balance, nausea and vomiting), a symptom of a “double spot” on the dressing when bleeding from the ear with otoliquore, hearing loss or hearing loss when drowning the opposite ear with a rattle, rams, paralysis of the facial nerve, meningeal and focal brain symptoms. When the maze is damaged, the sound in Weber’s experiment is lateralized into a healthy ear, and the hemothympanum without damage to the maze is manifested by lateralization of sound into the affected ear. With lumbar puncture, blood is found in the cerebrospinal fluid. Radiography of the temporal bones according to Schuller, Meyer and Stenvers, computer and magnetic resonance imaging for the diagnosis of the fracture line and the exclusion of intracranial hematoma are shown.
Treatment. First aid is to stop bleeding from the ear, for which they make the tamponade of the ear canal with sterile turundas or cotton wool, apply an aseptic bandage. The patient is transported lying on his back, providing immobility. In the hospital, with an increase in intracranial pressure, a lumbar puncture is performed. With heavy bleeding and signs of intracranial complications, they undergo extensive surgery on the middle ear. Removal of intracranial hematoma requires a neurosurgical aid
The prognosis for temporal bone injury depends on the nature of the skull base fracture and neurological symptoms. Extensive damage often leads to death immediately after injury. In the days following an injury, the cause of death is brain compression with a hematoma. Recovery is rarely complete. There remains a headache, dizziness, hearing loss or deafness, often with epileptiform seizures.
Otoliquorrhea usually stops on its own. With ongoing liquorrhea, an operation is performed on the middle ear with exposure of the dura mater and plasty of its defect in the temporal muscle.
Persistent facial paralysis requires surgical decompression. The bony canal of the nerve in the temporal bone is exposed and its epineural membrane is opened. When a nerve ruptures, the edges are sutured or neuroplasty is performed. The operation should be carried out before the onset of irreversible degenerative changes in the nerve (not later than 6 months from the moment of injury).
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Mechanical damage to the ear
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