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Damage to the inner ear (labyrinth)

Direct damage to the inner ear in peacetime is rare. It is possible mainly with the penetration of sharp objects (pins, pins, etc.) through the eardrum and the windows of the maze. Sometimes direct damage to the inner ear can occur during surgery on the middle ear (wounding of the horizontal semicircular canal or dislocation of the stapes from the vestibule window), as well as in fractures of the skull base accompanied by fractures of the temporal bone pyramid.

Damage to the inner ear is of great danger, primarily because the auditory and vestibular functions on the affected side are turned off. However, the danger also lies in the possible development of intracranial complications (pachyleptomeningitis, encephalitis, etc.) with infection from the inner ear into the posterior cranial fossa.

Fractures of the pyramid of the temporal bone. Fractures of the pyramid of the temporal bone in peacetime are relatively rare. They are usually combined with fractures of other bones involved in the formation of the base of the skull.

A fracture of the pyramid usually occurs as a result of striking the forehead or back of the head, in some cases when falling on the chin. A distinctive feature of these fractures is the lack of displacement of bone fragments.

By the nature of the location of the fault line, the pyramid-fractures are divided into longitudinal and transverse. In the first case, the integrity of the roof of the tympanic cavity and the upper wall of the ear canal is violated, in the second, the line of the gap crosses the entire array of the pyramid across.

Each of these types of fractures has certain symptoms. So, with a longitudinal fracture in the vast majority of cases, a rupture of the eardrum occurs, through which bleeding occurs, and often the outflow of cerebrospinal fluid. The auditory and vestibular functions, although impaired, are preserved.

Other violations in a transverse fracture - a complete loss of the functions of the inner ear and facial paralysis. The outer and middle ear do not suffer, as a result of which, with this fracture, bleeding from the ear and cerebrospinal fluid do not occur.

The diagnosis is based on the history (if possible) and examination. The patient immediately after the injury, as a rule, is in an unconscious state. Depending on the nature of the fracture, there may be bleeding and outflow of cerebrospinal fluid, paralysis of the facial and other cranial nerves. On the 2nd – 3rd day after the injury, bruising may occur under the conjunctiva of the eyeball and in the eyelids, where blood penetrates from the cellulose of the skull base along the loose fiber of the orbit, on the 4th – 5th day - under the skin of the base of the mastoid process. However, bleeding from the ear in some cases may be due to blood from the damaged integument of the skull or occurs when the external auditory canal is damaged, therefore, otoscopy must be performed without fail to avoid a diagnostic error.

If neurological symptoms allow, a X-ray of the skull is performed to clarify the nature of the fracture, lumbar puncture (blood in the cerebrospinal fluid), the fundus is examined, and the function of the inner ear is studied (if possible).

Treatment includes a number of organizational and therapeutic aspects. It is necessary to exclude the displacement of the patient’s head in relation to the torso, transportation from the scene to the medical institution is carried out in accordance with all precautions (shaking of the patient should be avoided, you can not turn it from side to side, tilt or tilt the head). In a medical institution, bleeding is stopped (if any) by loose administration of sterile turundum or a dry cotton swab into the ear canal. Usually produce lumbar puncture. Further therapeutic tactics are dictated by the patient’s condition, including neurological status.

The risk of injury to the temporal bone depends on the nature of the fracture of the base of the skull, its prescription and neurological symptoms (damage to the meninges and brain matter). Extensive damage often leads to death immediately after injury. In the coming days after injury, brain compression may be caused by large hematomas. Recovery is rarely complete; headache, dizziness remain, often epileptiform seizures occur.

Thermal and chemical injuries of the ear occur under the influence of high or low temperature, acids, alkalis, etc.

Thermal lesions of the outer ear are almost always combined with burns to the face, head and neck. With a burn, as with frostbite, 4 degrees are distinguished. The following degrees are characteristic of a burn: I - erythema, II - swelling and blistering, III - superficial necrosis of the skin, IV - deep necrosis, carbonization. For frostbite: I - swelling and cyanosis of the skin, II - blistering, III - necrosis of the skin and subcutaneous tissue, IV - cartilage necrosis.

Treatment First aid for thermal burns of the skin of the auricle and external auditory meatus is carried out according to the rules of general surgery. Anesthetics are prescribed - injections of morphine or pantopon. The affected areas of the skin are treated with a 2% solution of potassium permanganate or 5% aqueous solution of tannin. After opening, a 10–40% lapis solution is used to cauterize granulations. With necrosis, along with the removal of necrotic tissues, various antiseptic ointments are used corticosteroid preparations (suspension of hydrocortisone, etc.). In order to prevent possible atresia or narrowing in the first days after a burn, gauze turundas, soaked in 1% emulsion of synthomycin, are introduced into the ear canal; later, a rubber tube is inserted into the ear canal to form its lumen. If the victim has concomitant purulent inflammation of the middle ear, the necessary treatment of otitis media is performed.

First aid for frostbite of the auricle consists in warming it with warm (37 ° C) water, carefully wiping it with alcohol. In the formation of blisters, astringent solutions or ointments are used that contribute to their drying, or, observing strict asepticism, the bubbles are opened and the contents released from them, and then an ointment dressing with antibiotics is applied.

With necrosis, dead tissue is removed, napkins impregnated with Vishnevsky or Shostakovsky balm are applied, sulfonamide drugs and antibiotics are prescribed. With all degrees of frostbite, the use of physiotherapeutic methods of treatment (erythema doses of quartz radiation, UHF currents) is effective.

Often after frostbite, the auricle becomes hypersensitive to the effects of low and high temperatures. The skin of the auricle immediately after frostbite or with time may acquire a red or cyanotic color as a result of the development of venous thrombosis and persistent circulatory disorders.

With thermal burns of III and IV degrees, treatment should be carried out in a hospital. Help with chemical burns consists primarily in the urgent use of neutralizing substances (in case of a burn with acid they resort to neutralization with alkali, etc.), in the future, treatment tactics are similar to those carried out with thermal burns.

Acoustic injury occurs when short-term or long-term exposure to strong sounds on the organ of hearing.
There are acute and chronic acoustic injuries. The trauma is a consequence of the short-term action of super-strong and high sounds (for example, loud whistling woho, etc.). Their intensity is so great that the sensation of sound is usually accompanied by pain. Histological examination of the cochlea of ​​animals subjected to experimental acoustic trauma revealed hemorrhage in the cochlea, displacement and swelling of the cells of the organ of Corti.

In everyday life, chronic acoustic or noise trauma (hearing loss of weavers, riveters, etc.) is more common. The occurrence of chronic acoustic trauma is based on the so-called fatigue factor (the tiring effect of sounds on the organ of hearing). Hearing impairment caused by short-term noise is often reversible. On the contrary, prolonged and repeated exposure to sound can even lead to atrophy of the organ of Corti. With simultaneous and prolonged exposure to noise and vibration, the severity of hearing damage increases dramatically.

D and a gnostics based on the data of anamnesis, a general examination of the patient and the results of a hearing study. Usually, with acoustic trauma, treble hearing loss and shortening of bone sound conduction are observed.

Treatment. In the initial stages of occupational hearing loss, it is necessary to solve the problem of changing the profession. Persons working in a noisy industry must comply with the rest regime and the rules of personal protection from industrial noise. Treatment involves the implementation of the same measures as for sensorineural hearing loss, general strengthening therapy, and sedatives are needed. For the purpose of a general effect on the central nervous system, coniferous or hydrogen sulfide baths, vitamin therapy are recommended (vitamin C; B vitamins: B1, B6, B12, vitamins A and E, which have a positive effect on blood circulation and increase oxidative processes in the body).

Acoustic injury is carried out by a complex of medical and technical measures. It is very important to conduct a thorough professional selection (when applying for a job) and strictly defined deadlines for noisy medical examinations. Technical measures include reducing the intensity of sound in production by implementing measures aimed at sound absorption and sound insulation, the proper organization of work (the volume of low-frequency noise should not exceed 90-100 background, medium-frequency - 85-90 background, high-frequency - 75-85 background). Individual protective equipment involves the indispensable use of anti-noise devices of various designs (liners and tampons, helmets).

Vibration injury (vibration injury), as the name indicates, occurs due to vibrational vibrations (tremors) produced by various mechanisms (tools, vehicles). A study of the results of vibrational exposure in an animal experiment made it possible to detect degenerative changes in the cochlea (in the apical curl and spiral ganglion cells), as well as in the auditory and vestibular nuclei. The nature of these changes corresponds to the strength of the vibration and the duration of its impact.

Treatment is similar to that of acoustic trauma, given their close anatomical relationship. It should only be added that, in order to prevent vibration injuries, measures are taken for vibration isolation, vibration damping and vibration absorption.

Barotrauma appears when atmospheric pressure changes. The middle and inner ears are most sensitive to changes in such pressure.

There are 2 types of such injuries. In the first case, the injury develops when the pressure changes only in the ear canal, for example, when using a pneumatic Siegle funnel or an increase in pressure in the cavities of the middle ear, at the time of forced blowing of the auditory tube, etc. The second type of barotrauma is the effect of pressure differences in the environment and in the tympanic cavity, for example, when flying with pilots, diving with divers, caissons, etc. A combination of baro- and acoustic injuries occurs in explosions or shots at close distances (detonation). The basis of such violations is the mechanism of instant increase in atmospheric pressure and the sudden action of high frequency sound.

The otoscopic picture with barotrauma is characterized by the appearance of hyperemia of the tympanic membrane with hemorrhages in its thickness; sometimes there are tears or complete destruction of the eardrum. In the first 2 days after the injury, inflammatory changes may be absent. Subsequently, in case of attachment of a secondary infection, the development of an inflammatory process is possible. With hemorrhage in the tympanic cavity and with the intact membrane preserved, it acquires a dark blue color.

Along with the characteristic otoscopic picture with barotrauma, functional disorders of the inner ear and central nervous system occur. The patient develops noise and ringing in the ears, dizziness, nausea, hearing loss; sometimes there is a loss of consciousness.

The degree of hearing loss in barotrauma varies depending on where in the auditory analyzer the changes occurred.

In children, barotrauma sometimes develops when flying on an airplane, when the patency of the auditory tubes is impaired due to hypertrophy of the nasopharyngeal tonsil or peritube.

Treatment First aid for barotrauma, accompanied by a violation of the integrity of the eardrum, bleeding from the ear or hemorrhage in the thickness of the membrane, is a thorough but very careful cleaning of the ear canal from blood clots, possible impurities (explosion can get dirt) with sterile cotton wool, screwed to the probe. Any washing of the ear is strictly prohibited, since at this moment infection of the tympanic cavity may occur. After removing the contents of the external auditory meatus, his skin is carefully treated with cotton wool moistened with boric alcohol, and then the wound surface of the tympanic membrane is lightly dusted with triple sulfanilamide powder. Dry sterile turundas are introduced into the external auditory canal in order to prevent infection and for hemostasis. Dressings are done daily. If there are functional disorders of the inner ear (dizziness, etc.), the patient must comply with strict bed rest. General strengthening and anti-inflammatory therapy are prescribed. Starting from the 6th day, treatment is carried out depending on the nature of the lesion of a particular analyzer, in a clinic or hospital, depending on the nature and severity of traumatic injuries.

The risk of barotrauma consists primarily in observing safety measures that ensure a slow change in atmospheric pressure, in maintaining the normal function of the auditory tubes and, in particular, their patency. An important preventive value is the professional selection of people suitable for flight work, caisson and diving services.
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Damage to the inner ear (labyrinth)

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