Ear injuries — injuries of an auricle, external acoustical pass, a middle or inner ear various in character. Clinically depending on localization of the received injuries the injury of an ear can be shown by existence of a wound, an auricle separation, bleeding, pain, decrease in hearing, a congestion in an ear, ear noise, an incoordination, dizziness and nausea. With the diagnostic purpose at an injury of an ear the otoskopiya, a neurologic research, KT and a X-ray analysis of a skull, brain MRT, a research of vestibular and acoustical function is conducted. Treatment can be medicamentous and surgical. It includes processing of a wound, removal of hematomas, restoration of integrity of the damaged anatomical structures, infection prevention, antishock, antiedematous, infusional and anti-inflammatory therapy.
Most often in otolaryngology injuries of an external ear meet that is connected with its unprotected anatomic situation at which it easily is exposed to mechanical, thermal, chemical influences. Often the injury of an ear is followed by damage of several of its departments at once. The injury of an ear can be combined with a craniocereberal injury, a fracture of the lower jaw, a vertebral and spinal trauma in cervical department. In most cases the injury of an ear leads to development of this or that degree of relative deafness. The ear injury with injury of an auricle can become the reason of cosmetic defect which compensation will require application of methods of plastic surgery.
Injuries of an external ear
Clinic of injuries of external ear
Injury of an auricle is possible as a result of stupid, chipped , fire, thermal (burns and freezing injuries) or a chemical injury of an ear. The stupid injury of an ear and its wound can be followed by destruction of cartilages of an auricle, its full or partial separation, formation of a hematoma. The auricle bruise often leads to a blood congestion between a cartilage and perikhondriy. As a result the ear turns into red shapeless weight. The similar injury of an ear can be complicated by infection with development of abscess or a necrosis of cartilaginous tissue thanks to which the ear gains similarity to a cauliflower.
Damage of external acoustical pass meets less than the auricle injury, and is quite often combined with it. It is limited by a cartilaginous part of acoustical pass or extends to its bone part. The bullet or missile wound can be the cause of an injury of ear with damage of acoustical pass; blow by a sharp or blunt object to the area of an external opening of acoustical pass; hit in acoustical pass of a foreign matter, caustic chemicals, fire, hot steam or liquid. The strong blow in the lower jaw is capable to cause an ear injury with a change of a forward wall of a bone part of acoustical pass.
At an ear injury with damage of acoustical pass the victim complains of ear pain, bleeding from it, feeling of a strong congestion of an ear. At bleeding clots of blood accumulate in acoustical pass and obturirut it, causing the expressed conductive relative deafness. If the injury of an ear is not followed by injury of an eardrum, then after extraction of blood clots the complete recovery of hearing is observed. Thermal and especially chemical burns of external acoustical pass lead to formation of the hems blocking its gleam, development of a stenosis or full atresia of acoustical pass.
Diagnosis of injuries of external ear
It is enough to otolaryngologist or traumatologist to make its survey and a palpation for diagnostics of injuries of an auricle. The ear injury with damage of acoustical pass is diagnosed when carrying out an endoscopic research. Otoskopiya and a mikrootoskopiya are capable to reveal wounds of walls of acoustical pass, injury of an eardrum, a congestion in acoustical pass of clots of blood or stay in it of a foreign matter. The research allows to determine by the pugovchaty probe at an injury of an ear damages of cartilaginous and bone walls of acoustical pass. However changes of a bone part are better diagnosed by an aim X-ray analysis of a skull. As the stupid injury of an ear is quite often combined with brain concussion, all victims have to look round in addition the neurologist.
Treatment of injuries of external ear
At a stupid injury of an ear with the insignificant injuries of an auricle which are not followed by hemorrhage or injury of cartilages it is enough to carry out a toilet of an external ear, in the presence of grazes to process them iodine and to apply a dry bandage an ear. More serious injury of an ear is the indication to preventive reception of antibiotics for the prevention of development of an infection. In the presence of a hematoma it is opened, contents are evacuated through a section, provide adequate drainage and apply the pressing bandage an ear. In the presence of wounds make their preprocessing. Ruptures of cartilages of an auricle shinirut wadded tampons.
At an ear injury with a full separation of an auricle it is necessary to keep the torn-off element in cold and purity and to deliver as soon as possible together with the victim to the operating room where it is possible to carry out his sewing. Otherwise the victim will need an otoplastika for partial or full reconstruction of an auricle. If at an injury of an ear communication of an auricle with its basis remains, then it is enough to compare of them and to record the pressing bandage.
At an ear injury with wound of skin of external acoustical pass preprocessing of a wound is made. Then turunda with antibiotics and glucocorticosteroids are entered into acoustical pass. Bandagings with a toilet of acoustical pass and replacement carry out 1 time a day. The ruptures of a cartilaginous part of acoustical pass which occurred at an ear injury needs endoscopic restoration and the subsequent 48-hour fixing turundama tamponada with sintomitsinovy ointment. If the injury of an ear is followed by a change of a bone part of acoustical pass, then except the fixing tamponada the immobilization of the lower jaw from 1 to 2 weeks during which for an exception of chewing movements reception only of liquid food is allowed is necessary. At a post-traumatic atresia of acoustical pass reconstruction is carried out it.
Injuries of a middle ear
Clinic of injuries of middle ear
Injuries of a middle ear arise when the injury of an ear is followed by a rupture of an eardrum, concussion of a drum cavity or the getting wound. The barometric injury of an ear which arises at sharp pressure difference in and outside of a drum cavity is separately allocated. Injuries of an ear can lead to a change of acoustical stones, an incomplete dislocation or a rupture of their joints, stirrup basis shift. The ear injury with damage of a mastoidal shoot at infection leads to a mastoidit. The barometric injury of an ear is the cause of aero otitis, sometimes in combination with aero sinusitis.
At an ear injury with the getting wound of a drum cavity or perforation of an eardrum often there is an infection of a cavity of a middle ear to development of sharp average otitis. The last because of the reactivity of fabrics lowered as a result of a trauma in many cases becomes complicated mastoidity, can be transformed to chronic purulent average otitis or to become the reason of adhesive otitis. The ear injury with damage of a drum cavity is followed by a pain syndrome, noise in an ear, conductive relative deafness. At development of purulent otitis the gnoyetecheniye from external acoustical pass is noted.
Diagnosis of injuries of middle ear
The ear injury with damage of structures of a drum cavity is diagnosed on the basis of survey, an otoskopiya, the analysis of acoustical function and a radiological research. The endoscopic research can reveal the injuries of an eardrum, its change characteristic of purulent otitis, existence in external acoustical pass of purulent separated. These audiometriya, researches a tuning fork and a threshold audiometriya at an ear injury with injury of a middle ear testify to conductive type of decrease in hearing. The ear injury with damage of acoustical stones is followed by violation of their mobility that is defined during an acoustic impedansometriya. On the roentgenogram or the tomogram of a temporal bone at an injury of an ear changes of walls of a drum cavity and the increased lightness of cells of a mastoidal shoot can be observed.
Treatment of injuries of middle ear
At ear injuries with injury of a drum cavity or a mastoidal shoot obligatory antibiotic treatment from first days is required. At wounds preprocessing of wounds and the wound channel is made. At an ear injury with formation of a gemotimpanum the vasoconstrictive medicines removing hypostasis of an acoustical pipe that promotes more bystry evacuation on it the blood which accumulated in a drum cavity are recommended.
If the injury of an ear is followed by injury of an eardrum or acoustical stones, then after subsiding of inflammatory processes according to indications reconstructive operations are performed: timpanoplastika, stapedoplastika, miringoplastika, mastoidoplastika. In case of purulent complications at an ear injury depending on localization of process the sanifying operation, a mastoidotomiya or obshchepolostny operation is carried out. At the considerable damages resulting in resistant relative deafness victims with an injury of an ear need consultation of the doctor-slukhoprotezista for the solution of a question of the most optimum way of hearing aid.
Injuries of an inner ear
Clinic of injuries of inner ear
The ear injury with damage of structures of a labyrinth results from a contusion or wound (fragmental, bullet, pricking, intraoperative). In most cases it is combined with ChMT. At such injury of an ear as a result of the direct or mediated impact of the injuring factor on cages of the receptor device of a labyrinth the sharp or chronic traumatic labyrinth syndrome develops. It is shown by nausea, intensive dizziness, one - or bilateral noise in ears, feeling of rotation of surrounding objects, disorder of coordination, a spontaneous nistagm, neurotouch relative deafness. The similar injury of an ear can be followed by consciousness loss, paresis of a facial nerve on the party of damage, focal and all-brain neurologic symptomatology.
At strong influence of a sound the acoustic trauma is possible. The sharp acoustic injury of an ear is connected with short influence of a superstrong sound. At the same time in fabrics of a labyrinth hemorrhages are observed. As a rule, after their rassasyvaniye hearing restoration is observed. The chronic acoustic injury of an ear arises at long-term continuous impact of noise and is more often connected with production activity. Such injury of an ear leads to "exhaustion" of acoustical receptors and development of resistant relative deafness.
Diagnosis of injuries of inner ear
The ear injury with damage of a labyrinth is diagnosed by joint efforts of the traumatologist, otolaryngologist and neurologist. Neurologic survey, a X-ray analysis or KT of a skull, brain MRT, an otoskopiya is without fail made. If the condition of the ear which was injured with a trauma allows, then the research of the vestibular analyzer (a vestibulometriya, a stabilografiya, an elektronistagmografiya) and acoustical function (a threshold audiometriya, otoakustichesky issue, the promontorialny test) is conducted. At an acoustic injury of an ear great diagnostic value has the anamnesis of a disease.
Treatment of injuries of inner ear
At an ear injury with wound of a temporal bone and a labyrinth preprocessing of a wound is carried out, its adequate drainage is provided, the sterile bandage is applied. At satisfactory condition of the ear which was injured with a trauma carrying out otokhirurgichesky operation with the purpose of removal of foreign matters and restoration of anatomic integrity of the damaged structures of an inner ear is possible. Medical actions at an ear injury with a severe wound, concussion or a bruise of a brain substantially correspond to treatment of sharp ChMT and are held in neurosurgical or neurologic office. They are directed to maintenance of function of vitals, the prevention of hypostasis of a brain, prevention of a secondary infection, completion of blood loss, desintoxication. As the ear injury with damage of a labyrinth leads to an irreversible hearing disorder, after subsiding of its serious consequences victims need carrying out operations on restoration of hearing or hearing aid.