ME Disorders (Trauma) Flashcards
what is some etiology to trauma
Blow to the side of the head/falls
Sports injuries such as in racquet ball, football, boxing
Blast injuries (e.g., bombs/improvised explosive device – IEDs)
Motor vehicular accidents
Foreign body insertion such as Q-tips (ossicular disarticulation)
In cases of head trauma, the inner ear may be involved too resulting in SNHL with accompanying ME damage such as
™ perforation
ossicular disarticulation
hemotympanum (blood in the tympanic cavity)
how do you get disarticulation with Q tips
they are long and thin, happens if you shove it in too far and can result in a dead ear
etiology of ossicular disarticulation
Trauma to the head or face
Also seen in medical conditions such as osteoporosis
In cases of cholesteatoma where the pseudo-tumor can destroy the ossicles
Untreated ME infection that can destroy the ossicles
normal appearance of the middle ear ossicles on axial CT scan
ice cream cone
The ball of the ice cream is formed by the head of the _____ and cone is formed by the body of the ____, with the tapering conical point formed by the short process of the____
malleus, incus, incus
Failure of this normal configuration suggests ossicular chain disruption (incudomalleolar disarticulation)
ball of ice cream fell off
otoscopy findings of ossicular disarticulation
Depending on the cause of the disarticulation
Perforation of TM
Bleeding in the ear canal with TM perforation
Rarely, the TM and ear canal may appear normal
immitance results of ossicular disarticulation
Jerger type Ad tympanogram
Abnormal reflexes
pure tone results of ossicular disarticulation
conductive/mixed hl
treatment of ossicular disarticulation
Surgical repair
Amplification, if surgery is not successful/not an option
Majority of temporal bone injuries occur as part of multiple injuries following motor vehicular accidents (MVA)
true
temporal bone trauma is caused by
Industrial accidents
Recreational injuries
Falls
Assaults
Gunshot wounds
Self-inflicted injuries
temporal bone fractures occurs in ______% of head injuries
30-75%
types of temporal bone trauma
a. trauma with fracture
b. trauma without fracture
type a trauma with fracute
Longitudinal fractures
direct blow to temporal/parietal aspect)
Most common fractures of the temporal bone (70 to 90%)
Parallels long axis of the temporal bone in coronal plane
Passes through the postero-superior aspect of the external auditory canal, TM, and roof of ME
Disrupts the ossicles but generally spares the otic capsule
transverse fractures
commonly due to a blow to the occiput)
Less common fractures of the temporal bone (20 to 30%)
Extends through internal auditory canal or otic capsule – otic capsule disrupting fracture
Can affect the oval or round window
blunt trauma with fracture
Few temporal bone fracture are purely longitudinal or transverse
About 50 to 75% are mixed
otic barotraua
Barotrauma refers to injury sustained from failure to equalize the pressure of an air-containing space with that of the surrounding environment such as observed in the ear, face, and lungs
The most common examples of barotrauma occur in air travel and scuba diving
Barotrauma most often occurs during compression (descent) or after a short, shallow dive
Otic barotrauma causes sudden and severe negative ME pressure and trauma to the ear resulting in
Inner ear decompression sickness (IEDCS)
most often occurs during decompression (ascent) or shortly after surfacing from a dive
It is an injury that closely resembles inner ear barotrauma, however, the treatment is different
It is more common among commercial and military divers who breathe a compressed mixture of helium and oxygen
symptoms of IEDCS
HL & tinnitus
dizziness
Patients with IEDCS should be rapidly transported to a
hyperbaric chamber for recompression
Significant correlation between early recompression and recovery
thermal injuries
Injuries sustained during welding leading to TM perforation
Lightning bolt conducted through phone or other means
symptoms of thermal injuries
SNHL
Dizziness/vertigo
facial paralysis from devitalized bone and soft tissue
what are compressive injuries
When slapped or struck on the side of the head
Falling on water during water sports
Most significant is from blast injuries
what can bomb explosions cause
disruption & implosion of ™
HF SNHL due to disruption of the inner ear
what are auditory signs of injury
Acute or delayed conductive hearing loss
Clotted blood, debris, and hematoma in the ear canal
Perforated, lacerated, or completely disrupted TM
ME filled with blood or cerebrospinal fluid (CSF)
Bleeding from ears; common sign of temporal bone fracture
Ossicular disarticulation
Ossicular fixation due to fibrous adhesions
High incidence of SNHL
vestibular symtpoms of injury
Benign paroxysmal positional vertigo (BPPV)
Concussive injury to labyrinth resulting in vestibular symptoms
Perilymphatic fistula
80 to 90% of longitudinal temporal bone fractures result in
facial n paralysis
Self healing in 4 to 6 weeks
Myringotomy to drain is not recommended; high risk of infection
hemotympanum
Self-healing; observe and manage conservatively
Make sure perforated edges do not get infected, which may result in cholesteatoma
If healthy perforation persists after several months then a myringoplasty can be performed
tm perforation
Exploration and repair of ossicles
Amplification if surgery is not an option
persistent chl
treatment of rreversible SNHL and tinnitus
HA’s and tinnitus management
vestibular treatment
Mostly self-limiting resolving within 6 months
BPPV treatment
Typically self-limiting resolving within 3 months
If not resolved then treatment needed i.e., Epley maneuver
otitic meningitis treatmet
Meningitis can complicate traumatic encephalocele or CSF leak
may occur months or years later with or without CSF leak
Treated with antibiotics based on culture results
