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Ear damage occurs when a variety of factors act in peacetime (domestic, industrial, transportation, sports injuries, etc.), and it is especially common during a war. Injury may damage various parts of the ear. However, combined injuries are more often observed when organs adjacent to the ear are damaged. Among the damaging factors, the most common are mechanical, chemical and thermal. More rarely, damage by radiant energy - the so-called actinotrauma. A special place among the damaging factors is occupied by excessive acoustic exposure; vibrations and atmospheric pressure drops. With such types of injuries, disorders in the middle ear and degenerative changes in the receptor apparatus of the inner ear often occur.
Damage can be superficial when only soft tissues of the ear are injured without breaking the bones (the outer ear, the skin of the external auditory canal and the eardrum), and deep, which are accompanied by cracks, fractures of the pyramid of the temporal bone, etc. The latter can be diagnosed using X-ray examination (computed tomography of the temporal bone is especially effective) and based on a number of clinical symptoms.
Mechanical damage Damage to the ear shell. The auricle often undergoes various injuries. Superficial damage to the auricle can occur as a result of a bruise, shock, bite, etc. In some cases, there is a partial or complete separation of the shell.
Infection of the wound in the auricle at the time of injury and a delay in care may result in perichondritis (inflammation of the perichondrium) or chondritis, followed by melting of the cartilage and deformation of the auricle.
Treatment With a superficial wound without involving the perichondrium, economical surgical treatment is performed, the skin edges are smeared with 5% tincture of iodine, and powdered penicillin or streptocide are insufflated. Sutures must be done earlier and no more than 2 days after the injury. Torn (partially or completely) pieces of the auricle after processing are sewn into place with frequent sutures. A cosmetic seam is preferred. Apply an aseptic dressing. Assistance ends with the introduction of tetanus toxoid. In the future, wounds are ligated daily. Physiotherapy is prescribed (UV radiation, UHF currents, etc.) and antibiotics (augmentin parenterally, rulide, etc.).
When suppuration of the wound, the sutures are removed and, if necessary (development of perichondritis), additional skin incisions are made to evacuate the pus. The wound in this case heals by secondary intention.
Deep wounds, including partial or complete detachment of the auricle, are treated according to the rules of primary surgical treatment, i.e. foreign bodies are removed, crushed tissues are excised, however, they are sparingly applied to the edges of the wound. Deeply penetrating wounds (punctured, incised, chopped) can be accompanied by an injury to the bones of the skull, eardrum, etc. , brain concussion).
The otogematoma occurs as a result of a bruise of the auricle or prolonged pressure on it, and hemorrhage between the cartilage and periosteum is possible. This condition is called otogematoma; it is usually located on the front surface of the upper half of the auricle. On examination, a fluctuating swelling of red color with a bluish tinge is determined in a rounded shape. Palpation of the otogematoma, as a rule, is painless; if, at the time of impact, the perichondrium and cartilage are injured, soreness will be a mandatory symptom. The contents of the otogematoma are blood and lymph. In some cases, the otogematoma suppurates due to infection under the perichondrium.
Treatment. Small otogematomas often resolve spontaneously or after applying a pressure dressing to the sink. With large hematomas, a puncture is sterile with suction of the contents. For several days, apply a pressure bandage. When suppuration without delay, a wide section is made to remove the products of inflammation, the wound is washed with a solution of penicillin in novocaine, soft drainage (glove rubber) is introduced and a bandage is applied; subsequently frequent dressings are necessary.
Damage to the external auditory canal can be localized in the cartilage and bone; they can be direct or indirect. Both parts of the ear canal are less commonly affected.
Immediate isolated damage to the bony walls of the ear canal is rare. They are usually combined with damage to the zygomatic and mastoid processes, the joint of the lower jaw, and often damage to the tympanic cavity, in particular, with fractures of the base of the skull. Damage to the bony part of the ear canal and the inner ear is not excluded.
Indirect (indirect) damage to the bone walls of the external auditory meatus are relatively common; they occur when falling on the lower jaw and striking the chin. In these cases, there are fractures of the lower anterior wall of the auditory meatus, accompanied by bleeding from the ear, pain when chewing, opening the mouth.
D and a gnostics is based on the data of anamnesis, external examination, otoscopy, sounding and radiography of the temporal bones and joint of the lower jaw. In diagnostics, methods for studying auditory and vestibular functions are important.
Treatment First aid comes down to primary treatment of the wound, including stopping bleeding and washing the wound with a disinfectant solution, and administering tetanus toxoid according to the scheme. To prevent the possible development of narrowing or even atresia as a result of scarring, as well as to eliminate inflammation from the first day, tamponade of the auditory meatus with turundas soaked in sterile paraffin oil, streptocid or sintomycin emulsion, etc. At each ligation, 10 drops of a hydrocortisone suspension are injected into the ear canal.
Later, if necessary, and when the inflammatory phenomena subside, a tubular dilator made of rubber or plastic is introduced into the external auditory canal. Such treatment is carried out against the background of the general use of antibiotics. Physiotherapy is also prescribed in the form of quartz through a tube into the ear canal, UHF currents, microwaves.
In case of fractures of the anteroposterior wall of the external auditory canal, only liquid food is prescribed, and to prevent possible displacement of the fragmented bone wall, the lower jaw is fixed with a bandage. Treatment of patients with injuries of the external auditory canal is carried out in the ENT hospital.
Damage to the eardrum. There are direct and indirect injuries of the eardrum. Direct damage can occur when using various objects (matches, pins, etc.) to clean the ear, which lead to rupture of the eardrum during accidental shocks. Damage to the eardrum by small branches when walking or running along the bush, as well as in cases of inept attempts to remove a foreign body from the ear canal. Eardrum ruptures occur during longitudinal fractures of the pyramid of the temporal bone, when the line of fracture passes through the tympanic ring.
Damage to the eardrum can be observed with a sudden thickening or rarefaction of air in the external auditory canal, for example, when falling on the ear, hitting it, jumping from a height into the water. These injuries occur when violating the rules of compression and decompression by divers and caissons, during an aerial injury, and also as a result of the action of an air wave during explosions at close range. In these cases, rupture of the eardrum in the absence of proper treatment often leads to the development of chronic suppurative otitis media.
Damage to the tympanic membrane can be limited to trauma to the vessels with point hemorrhages in its thickness, but often lead to rupture of the membrane of various shapes; less common is its complete destruction (when exposed to steam, hot liquid or a chemical substance). Damage to the eardrum is accompanied by the appearance of a sudden sharp pain, noise in the ear and hearing loss. Through perforation during otoscopy, you can sometimes see the medial wall of the tympanic cavity.
Treatment. The patient and the doctor should be very careful not to introduce the infection into the middle ear, therefore any manipulations (removal of blood clots, drying) in the ear should be avoided. Ear washing is categorically contraindicated. First aid should be limited to the introduction into the external auditory meatus of a dry sterile turunda or cotton ball with boric alcohol. From the first day after the injury, drugs are not injected into the ear. After 5-6 days, the ear canal is carefully cleaned. In cases where the eardrum is perforated, the edges of the gaping hole are very carefully lubricated with a 20% lapis solution to cause granulation and covered with a rubber (from a glove) or protein (from an egg) film. If unsuccessful, a myringoplasty is done in a month. In the first days after an injury with yawning perforations, synthetic films coated with human allofibroblasts are successfully used; closure of perforation occurs in almost all patients (A.A. Pomatilov). Active general and local anti-inflammatory treatment is the same as in acute otitis media, it is indicated with the appearance of purulent discharge from the ear.
Traumatic otitis media and mastoiditis. Acute inflammation of various parts of the middle ear due to trauma - a blow, a gunshot wound, an explosive wave, along with the usual picture of inflammation, have flow features that must be taken into account in diagnosis and treatment.
With these injuries, it is first necessary to recognize and assess the damage to the skull, brain, spine and, depending on this, determine further diagnostic and therapeutic tactics together with a neurologist and neurosurgeon. The presence of symptoms of a fracture of the base of the skull or spine indicates the need for immediate fixation of the patient's head and body. Ear injury is accompanied by rupture of the eardrum, which can lead to secondary infection of the tympanic cavity and the development of acute otitis media. With an entire eardrum after injury, the infection can enter through the auditory tube. Reducing tissue reactivity after an injury can lead to the development of mastoiditis. An open wound of the mastoid is always infected. In this regard, the spread of infection into the tympanic cavity with the development of acute inflammation is possible. Primary surgical treatment is always necessary with an open wound. Turunda with boric alcohol is loosely introduced into the ear canal; antibiotic therapy is prescribed.
The blast wave is always accompanied by a sharp increase in air pressure in the external auditory canal, which causes perforation of the eardrum and in the very near future - acute otitis media. Since there is no accumulation of pathological discharge in the tympanic cavity (it flows out through perforation), the pain in the ear is slight, the body temperature is subfebrile or normal, and the reaction in the blood is insignificant. Discharge from the ear is first serous-bloody, and then mucous. A sharp decrease in hearing indicates damage to the inner ear, as well as dizziness, spontaneous nystagmus, which can be both peripheral (unilateral) and central (bilateral).
Treatment always involves the use of antibiotics. Imaginary well-being should not be the reason for stopping treatment.
In the development of gunshot mastoiditis, it is characteristic that immediately from the moment of injury, a bone is involved in the inflammatory process. Due to the open wound, the outflow of contents is usually good. The presence of cracks and fractures of the walls of the process promotes the transition of infection to the contents of the skull and the development of intracranial complications.
Surgical treatment for gunshot mastoiditis. The wound is opened, necrotic tissue and bone fragments are removed; cracks clean, create good drainage of the wound. The prognosis depends on the severity of the injury.
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