The four main types of ear trauma A road map for diagnosis and management

1. Traumatic conditions of the ear
Dr. Hazem M. Abdel Tawab
Professor and Consultant of ORL, HNS
Medical Doctorate of ORL, HNS
Faculty of Medicine, Cairo University, Egypt
Dr Hazem M. Abdel Tawab, ENT, Cairo 1

2. ❶Traumatic rupture of ear drum
• Etiology
Indirect:
-Slap to the face
-Explosion
-Otitis barotrauma
Dr Hazem M. Abdel Tawab, ENT, Cairo 2

3. Traumatic rupture of ear drum
Direct
-Self induced as cotton bud
-Doctor induced (Iatrogenic)
Ear wash/ foreign body removal
-Road or fall induced (fracture
Skull base : longitudinal)
Dr Hazem M. Abdel Tawab, ENT, Cairo 3

4. Clinical picture: Symptoms
• History
• Pain at the trauma time only unless infected
• Decreased hearing (CHL) + tinnitus
• Minimal bleeding / more in longitudinal fracture skull base
• Whistling sound
Dr Hazem M. Abdel Tawab, ENT, Cairo 4

5. Clinical picture: Signs
• Blood clots in ear canal /fresh in skull base fracture
• Serrated edges of the perforation in pars tensa
• Tuning fork CHL
• Never clean blood or blood clots
Dr Hazem M. Abdel Tawab, ENT, Cairo 5

6. Differential diagnosis
(Traumatic/pathological)
History: Trauma/ OM
Canal: -
Blood in trauma/ may be in pathological in exacerbation
Discharge in pathological in exacerbation/ may be in
traumatic if infection
Dr Hazem M. Abdel Tawab, ENT, Cairo 6

7. Differential diagnosis
(Traumatic/pathological)
Drum perforation:
Site: central tensa/ central or attic tensa or flaccida
Size: small/ any size
Shape: irregular serrated/ regular
Edges: This with clots/ thick fibrous
Middle ear mucosa: normal unless infection/ congested in
exacerbation
Dr Hazem M. Abdel Tawab, ENT, Cairo 7

8. Treatment
• Nothing:
• Don’t let water inside/don’t give drops
• Don’t blow your nose
• Might give systemic antibiotic with well evidence as
prophylaxis
• Give a chance for healing usually one month
• Myringoplasty after 3-6 months if failed spontaneous
healinge
Dr Hazem M. Abdel Tawab, ENT, Cairo 8

9. ❷Otitic barotrauma
• Trauma to the middle ear by atmospheric pressure changes when
compared to middle ear pressure as in descent in a flight or
diving
Eustachian tube obstruction
• What causes obstruction of Eustachian tube?
- Common cold/ adenoid
- Deviated septum or polyps
Dr Hazem M. Abdel Tawab, ENT, Cairo 9

10. Mechanism
Dr Hazem M. Abdel Tawab, ENT, Cairo 10

11. Mechanism
Dr Hazem M. Abdel Tawab, ENT, Cairo 11

12. Clinical picture
• Ear fullness
• Decreased hearing and tinnitus
• Discomfort then pain
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Otoscope: retraction then effusion or blood in middle ear then
rupture
Tuning fork: CHL
Dr Hazem M. Abdel Tawab, ENT, Cairo 12

13. Treatment
Prophylaxis
Avoid flying with common cold
Avoid sleeping in the cabin
you may use nasal decongestants if common cold
You may chew gum/ Valsalva/ Toynbee
Dr Hazem M. Abdel Tawab, ENT, Cairo 13

14. Treatment
In mild cases decongestants and Valsalva
In moderate cases myringotomy
In severe cases myringoplasty?
Dr Hazem M. Abdel Tawab, ENT, Cairo 14

15. ❸Fracture skull base
• RTA : Road traffic accident
Dr Hazem M. Abdel Tawab, ENT, Cairo 15

16. Longitudinal skull base fracture
Dr Hazem M. Abdel Tawab, ENT, Cairo 16
• Incidence : more 80%/ yet less dangerous
• Trauma to side of the head passes through
external ear drum ossicles middle ear
• Ear canal lacerations/ ear drum perforation/ ossicular chain
disruption
• CHL
• What about facial nerve: Trauma line parallel >>edema and
compression 20%
• Facial is delayed/ recovery more likely

17. Transverse skull base fracture
• Incidence: less 20%/ yet more dangerous
• Trauma to back of the head passes through inner
ear and facial canal
• No ear canal or ear drum problem
• Hemotympanum/ SNHL/ mixed
• Facial injury early not recovering conservatively= cut
• Facial 50% of cases in this type
• Needs intervension
Dr Hazem M. Abdel Tawab, ENT, Cairo 17

18. Investigations
• CT scan why? fracture
• MRI why? Brain and nerve
Dr Hazem M. Abdel Tawab, ENT, Cairo 18

19. Treatment
• Hospitalization
• Don’t manipulate by suction or cotton buds
• Antibiotics
• Steroids?
• Neurosurgeon (stabilization)
• Facial nerve repair or drum repair or ossicular repair hemotympanum
aspiration comes late after stabilization
Dr Hazem M. Abdel Tawab, ENT, Cairo 19

20. ❹Trauma to inner ear
Physical: Sound
Acute noise exposure as in explosions
Chronic noise exposure as in factories
Mechanical: Trauma
Accidental as transverse fracture skull base
Surgical as stapedectomy and mastoidectomy (perilymph fistula)
Dr Hazem M. Abdel Tawab, ENT, Cairo 20

21. Treatment
• Conservative: rest
avoid ototoxic
avoid noise exposure
Antibiotics in mechanical type
• Surgical: fistula repair
• Hearing aids
Dr Hazem M. Abdel Tawab, ENT, Cairo 21

22. Thank you
Dr Hazem M. Abdel Tawab, ENT, Cairo 22