Traumatic Injuries of the Ear and Temporal Bone

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Chapter 634 Traumatic Injuries of the Ear and Temporal Bone

Joseph Haddad, Jr.

Auricle and External Auditory Canal

Auricle trauma is common in certain sports, and quick drainage of a hematoma can prevent irreversible damage. Hematoma, with accumulation of blood between the perichondrium and the cartilage, can follow trauma to the pinna and is especially common in teenagers related to wrestling or boxing. Immediate needle aspiration or, when the hematoma is extensive or recurrent, incision and drainage and a pressure dressing are necessary to prevent perichondritis, which can result in cartilage loss and a cauliflower ear deformity. Sports helmets should be worn when appropriate during activities when head trauma is possible.

Frostbite of the auricle should be managed by rapidly rewarming the exposed pinna with warm irrigation or warm compresses.

Foreign bodies in the external canal are common in childhood. Often these can be removed in the office setting without general anesthesia if the child is mature enough to understand and cooperate and is properly restrained; if an adequate headlight, surgical head otoscope, or otomicroscope is used for visualizing the object; and if appropriate instruments, such as alligator forceps, wire loops or a blunt cerumen curette, or suction are used, depending on the shape of the object. Gentle irrigation of the ear canal with body temperature water or saline may be used to remove very small objects, but only if the tympanic membrane (TM) is intact. Attempts to remove an object from a struggling child or with poor visualization and inadequate tools results in a terrified child with a swollen and bleeding ear canal and can then mandate general anesthesia to remove the object. Difficult foreign bodies, especially those that are large, deeply embedded, or associated with canal swelling, are best removed by an otolaryngologist and/or under general anesthesia. Disk batteries are removed emergently because they leach a basic fluid that can cause severe tissue destruction. Insects in the canal are first killed with mineral oil or lidocaine and are then removed under otomicroscopic examination.

After a foreign body is removed from the external canal, the TM should be inspected carefully for possible traumatic perforation or for a pre-existing middle-ear effusion. If a foreign body has resulted in acute inflammation of the canal, eardrop treatment as described for acute external otitis should be instituted (Chapter 631).

Tympanic Membrane and Middle Ear

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