Ear emergency and trauma Flashcards
What causes pinna haematoma?
Application of shearing forces to the auricle, usually found in rugby players and boxers
Describe the pathophysiology of pinna haematoma
- Initial trauma
- Perichondrial blood vessels tear
- Haematoma forms between auricular cartilage and overlying perichondrium
What can occur if pinna haematomas are left untreated?
Disruption of blood supply to the underlying cartilage causes avascular necrosis
This causes fibrocartilage overgrowth leading to structural deformity (Cauliflower ear)
What is cauliflower ear?
Fibrocartilagenous overgrowth of the auricular cartilage caused by untreated pinna haematoma
What condition is shown?
Pinna haematoma
How is pinna haematoma managed?
Aspiration, incision and drainage, or pressure dressing
What are the 2 classes of temporal bone fracture?
Longitudinal
Transverse
What is meant by a longitudinal temporal bone fracture?
Fracture line parallel the long axis of the petrous pyramid
What usually causes longitudinal temporal bone fracture?
Lateral blow to the head
What is a transverse temporal bone fracture?
Fracture at right angles to the long axis of the petrous pyramid
What is the most common cause of transverse temporal bone fracture?
Fronto-occipital head trauma
What are some possible complications of longitudinal temporal bone fracture?
- Conductive deafness (Hemotympanum and ossicular chain disruption)
- Facial palsy
- CSF leak
- Bleeding from external canal due to laceration of skin and ear drum
What are some signs of temporal bone fracture?
- Bruising - Battle sign
- Bruising over mastoid, indicates base of skull fracture
- Condition of TM and ear canal
- Cranial nerve examination, especially CN VII
- Hearing test
What is shown?
Battle’s sign of temporal bone fracture
What are some possible complications of transverse temporal bone fracture?
- Damage to auditory and facial nerves
- Sensorineural hearing loss due to CN VIII damage
- Facial palsy
- Vertigo
What investigation is required for temporal bone fracture?
CT scan
What is the management of temporal bone fracture?
Most commonly conservative management
How is sudden conductive hearing loss after trauma managed?
- Facial nerve decompression
- Manage CSF leak
- Hearing aids or ossicuoplasty
How is sudden sensorineural hearing loss after trauma managed?
- Treat as emergency
- Weber test
- High dose steroids (1 mg/kg)
- Consider intratypanic treatment
What condition is shown?
Sudden sensorineural hearing loss
How are most foreign bodies in the ear managed?
Wait until urgent clinic for removal
What foreign body needs to be removed immediately from the ear?
Batteries
How are live animals in the ear removed?
Drown with oil, remove the next day
What causes CSF leak?
Fracture of the skull and meninges rupture
How does CSF leak present?
Persistent, clear otorrhoea or rhinorrhoea
How is CSF leak managed?
- Often settle spontaneously
- Need repair if does not resolve within 10 days
- Do not give antibiotics initially - can mask meningitis
What are some common causes of ear lacerations?
- Blunt trauma
- Avulsion
- Dog bites
How are ear lacerations managed?
- Debridement
- Closure - primary or secondary
- Usually under local anaethetic
- Cover with antibiotics - exposed cartilage
What is a possible complication of ear laceration?
Tissue loss
