Ear emergency and trauma

Question 1

What causes pinna haematoma?

Answer 1

Application of shearing forces to the auricle, usually found in rugby players and boxers

Question 2

Describe the pathophysiology of pinna haematoma

Answer 2

1. Initial trauma
2. Perichondrial blood vessels tear
3. Haematoma forms between auricular cartilage and overlying perichondrium

Question 3

What can occur if pinna haematomas are left untreated?

Answer 3

Disruption of blood supply to the underlying cartilage causes avascular necrosis
This causes fibrocartilage overgrowth leading to structural deformity (Cauliflower ear)

Question 4

What is cauliflower ear?

Answer 4

Fibrocartilagenous overgrowth of the auricular cartilage caused by untreated pinna haematoma

Question 5

What condition is shown?

Answer 5

Pinna haematoma

Question 6

How is pinna haematoma managed?

Answer 6

Aspiration, incision and drainage, or pressure dressing

Question 7

What are the 2 classes of temporal bone fracture?

Answer 7

Longitudinal
Transverse

Question 8

What is meant by a longitudinal temporal bone fracture?

Answer 8

Fracture line parallel the long axis of the petrous pyramid

Question 9

What usually causes longitudinal temporal bone fracture?

Answer 9

Lateral blow to the head

Question 10

What is a transverse temporal bone fracture?

Answer 10

Fracture at right angles to the long axis of the petrous pyramid

Question 11

What is the most common cause of transverse temporal bone fracture?

Answer 11

Fronto-occipital head trauma

Question 12

What are some possible complications of longitudinal temporal bone fracture?

Answer 12

• Conductive deafness (Hemotympanum and ossicular chain disruption)
• Facial palsy
• CSF leak
• Bleeding from external canal due to laceration of skin and ear drum

Question 13

What are some signs of temporal bone fracture?

Answer 13

• 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

Question 14

What is shown?

Answer 14

Battle’s sign of temporal bone fracture

Question 15

What are some possible complications of transverse temporal bone fracture?

Answer 15

• Damage to auditory and facial nerves
• Sensorineural hearing loss due to CN VIII damage
• Facial palsy
• Vertigo

Question 16

What investigation is required for temporal bone fracture?

Answer 16

CT scan

Question 17

What is the management of temporal bone fracture?

Answer 17

Most commonly conservative management

Question 18

How is sudden conductive hearing loss after trauma managed?

Answer 18

• Facial nerve decompression
• Manage CSF leak
• Hearing aids or ossicuoplasty

Question 19

How is sudden sensorineural hearing loss after trauma managed?

Answer 19

• Treat as emergency
• Weber test
• High dose steroids (1 mg/kg)
• Consider intratypanic treatment

Question 20

What condition is shown?

Answer 20

Sudden sensorineural hearing loss

Question 21

How are most foreign bodies in the ear managed?

Answer 21

Wait until urgent clinic for removal

Question 22

What foreign body needs to be removed immediately from the ear?

Answer 22

Batteries

Question 23

How are live animals in the ear removed?

Answer 23

Drown with oil, remove the next day

Question 24

What causes CSF leak?

Answer 24

Fracture of the skull and meninges rupture

Question 25

How does CSF leak present?

Answer 25

Persistent, clear otorrhoea or rhinorrhoea

Question 26

How is CSF leak managed?

Answer 26

• Often settle spontaneously
• Need repair if does not resolve within 10 days
• Do not give antibiotics initially - can mask meningitis

Question 27

What are some common causes of ear lacerations?

Answer 27

• Blunt trauma
• Avulsion
• Dog bites

Question 28

How are ear lacerations managed?

Answer 28

• Debridement
• Closure - primary or secondary
• Usually under local anaethetic
• Cover with antibiotics - exposed cartilage

Question 29

What is a possible complication of ear laceration?

Answer 29

Tissue loss