Pinna Trauma FB and Wax

Question 1

What is pinna haematoma?

Answer 1

Bleeding underneath the ear’s perichondrium that causes separation of the perichondrium from the cartilage itself. This results in ischaemia of the cartilage and scarring – also known as cauliflower ear.

Question 2

What are the risk factors for pinna haematoma?

Answer 2

Rugby
Wresting
Blunt trauma

Question 3

What are the clinical features of pinna haematoma?

Answer 3

Swollen ear
History of trauma
Pain

Question 4

What is the management of pinna haematoma?

Answer 4

Incision of haematoma and primary closure
Also packing to prevent reaccumulation
Cover with antibiotics as secondary infection causes major loss of cartilage

Question 5

Is wax normal?

Answer 5

Wax or Cerumen production varies massively between people. Important to impress on patients that wax is normal and will move of its own accord – it is serving a function. However some people may produce excessive wax which becomes compacted.

Question 6

What are the clinical features of excessive wax in the ear?

Answer 6

Dull hearing
Fullness in the ear
Tinnitus

Question 7

How is excessive wax managed?

Answer 7

Strongly advise against cotton bud use
Soften with olive oil then syringing (post procedure dizziness)
Ear drops can remove wax – give whilst patient is lying on side affected ear up – pour 3 drops for 7 days
Suction under direct vision

Question 8

How should ear FB be managed?

Answer 8

Very common especially in children. Always refer to ENT as you are more likely to push something in further than to get it out unless it is very close to the entrance. Any instrumentation must be done under direct vision. Use crocodile forceps if soft but if solid a wax hook or Jobson-Horne probe is best.

Question 9

How is tympanic membrane perforation managed?

Answer 9

Can be perforated by direct or baro-trauma but most commonly occurs as a result of infection. This causes pain and possibly conductive hearing loss. Most can be allowed to heal by themselves so all patients must do is avoid water. If the perforation is large or has not healed after 6-8 weeks, then myringoplasty can be performed.

Question 10

What is the relevance of haemotympanum?

Answer 10

Presence of blood behind the ear. Indicates basilar skull fracture. If temporal bone involved then there will also be CSF, dizziness, bruising behind the eyes and ears, facial weakness and difficulty seeing, smelling or hearing

Question 11

When should an ear not be irrigated?

Answer 11

Do not irrigate if ear drum perforated, grommets or under 1.5yrs, cleft palate or post-mastoid surgery.