Ain Shams University

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Ain Shams Ain Shams University University ENT Department ENT Department

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Ain Shams University. ENT Department. The Ear. Trauma to External Ear Haematoma Auris. It is collection of blood under auricular perichondrium. - PowerPoint PPT Presentation

Transcript of Ain Shams University

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Ain Shams UniversityAin Shams University

ENT DepartmentENT Department

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The EarThe Ear

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Trauma to External EarTrauma to External EarHaematoma AurisHaematoma Auris

It is collection of It is collection of blood under auricular blood under auricular perichondrium. perichondrium.

It is either due to direct It is either due to direct trauma (trauma (boxers earboxers ear) or ) or spontaneous due to spontaneous due to haemorrhagic blood haemorrhagic blood disease or degenerative disease or degenerative vascular disease.vascular disease.

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Treatment of Haematoma AurisTreatment of Haematoma Auris

Aspiration Aspiration if blood still fluid or if blood still fluid or Incision Incision and evacuation if clotted and and evacuation if clotted and pressure pressure

bandagebandage & prophylactic antibiotics. & prophylactic antibiotics. If untreatedIf untreated fibrosis of the clot and fibrosis of the clot and

permanent thickening permanent thickening (cauliflower ear(cauliflower ear))

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Perichondritis Of Auricular Perichondritis Of Auricular CartilageCartilage

It is infection of the It is infection of the auricular cartilage which may lead to auricular cartilage which may lead to necrosis. Shrinkage and deformity necrosis. Shrinkage and deformity of the auricle may result. of the auricle may result.

CausesCauses 1. 1. Complication ofComplication of Haematoma Auris. Haematoma Auris.

2. Complication of surgical operations for 2. Complication of surgical operations for

chronic otitis media, or of traumatic chronic otitis media, or of traumatic lacerations of the auricle. lacerations of the auricle.

3. Furuncle of the external auditory 3. Furuncle of the external auditory canal.canal.

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Treatment of PerichondritisTreatment of Perichondritis1- Antibiotics1- Antibiotics

2- Wide incision 2- Wide incision and drainage and drainage with excision with excision of the necrotic of the necrotic cartilage.cartilage.

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Traumatic perforation of Tympanic MembraneTraumatic perforation of Tympanic Membrane Causes:Causes:

1- Direct trauma1- Direct trauma

a)a) Self inflected. Self inflected.

b)b) F.B. in ext. auditory F.B. in ext. auditory canal or unskilled canal or unskilled attempts to remove.attempts to remove.

c)c) Fractured base of Fractured base of skull extending to skull extending to attachment of the attachment of the D.M. D.M.

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Traumatic perforation of Tympanic MembraneTraumatic perforation of Tympanic Membrane(cont.)(cont.)

2-2- Sudden air compressionSudden air compression Hand slapHand slap (the (the most most

common causecommon cause).). Explosions (blast)Explosions (blast) Otitic barotrauma.Otitic barotrauma. Over inflation of the Over inflation of the

Eustachian tube.Eustachian tube.

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Traumatic perforation of Tympanic MembraneTraumatic perforation of Tympanic Membrane(cont.)(cont.)

3- Sudden water compression3- Sudden water compression - Unskilled ear wash.- Unskilled ear wash. - Diving or water polo. - Diving or water polo.

SymptomsSymptoms 1- 1- Pain Pain & & vertigovertigo may occur at the time may occur at the time

of rupture. of rupture. 2- 2- DeafnessDeafness, tinnitus & autophony. , tinnitus & autophony. 3- Air may come out of the ear on nose 3- Air may come out of the ear on nose blowing.blowing.

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Traumatic perforation of Tympanic MembraneTraumatic perforation of Tympanic Membrane(cont.)(cont.)

Signs:Signs: the perforation is in the perforation is in membrana tensamembrana tensa, with , with irregularirregular or triangular shape and with or triangular shape and with few blood few blood clots clots around it.around it.

Differential Diagnosis:Differential Diagnosis: 1- 1- self inflectedself inflected There is There is hesitation markshesitation marks on the on the

skin of the deep meatus , it is skin of the deep meatus , it is usually in the usually in the postro-inferior postro-inferior quadrantquadrant of the D.M. and of the D.M. and smallsmall in size.in size.

2- 2- Pathological perforationPathological perforation

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Traumatic Traumatic perforationperforation

Pathological Pathological perforationperforation

Shape Shape Irregular or Irregular or triangular with triangular with thin edge and thin edge and surrounded by surrounded by blood clotsblood clots

Regular Regular rounded or rounded or kidney shaped kidney shaped with thick with thick edge and may edge and may be surrounded be surrounded by pus.by pus.

T M remnantsT M remnants NormalNormal Thick& opaqueThick& opaque

M E mucosaM E mucosa NormalNormal InflamedInflamed

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Treatment:Treatment:1- 1- Instruct the patientInstruct the patient to to avoidavoid water water

from entering the ear (put cotton from entering the ear (put cotton with vaseline during bathing)also with vaseline during bathing)also avoid any ear drops.avoid any ear drops.

2- 2- Avoid blowingAvoid blowing of the nose violently. of the nose violently. 3- Prophylactic 3- Prophylactic AntibioticsAntibiotics.. 44- Myringoplasty- Myringoplastyoperation: operation: The perforation usually heals within The perforation usually heals within

3 weeks , but there is hope for 3-6 3 weeks , but there is hope for 3-6 menthes, but if still present, do menthes, but if still present, do myringoplasty operation.myringoplasty operation.

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Otitic BarotraumaOtitic BarotraumaIt occurs during descent by It occurs during descent by

aircraft or during diving.aircraft or during diving.

Cause Cause : air pressure in high : air pressure in high altitude is low and when altitude is low and when the aircraft descent the aircraft descent rapidly the pressure rapidly the pressure increase and become more increase and become more than that in the middle than that in the middle ear so air must go through ear so air must go through Eustachian tube to middle Eustachian tube to middle ear.ear.

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Otitic Barotrauma Otitic Barotrauma (cont.)(cont.)

If Eustachian tube does not open If Eustachian tube does not open (due to edema in its wall as in (due to edema in its wall as in rhinitis or allergy or during sleep rhinitis or allergy or during sleep or no swallowing). or no swallowing). There will be There will be negative pressure in the middle negative pressure in the middle ear.ear.

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Otitic Barotrauma Otitic Barotrauma (cont.)(cont.)

The negative pressure in the middle ear will lead to:

1- Retraction of the drum membrane that may lead to rupture.

2- Congestion and edema of m.m. of middle ear followed by transudation of Fluid.

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Otitic Barotrauma Otitic Barotrauma (cont.)(cont.)Clinical Picture:1.Pain and deafness &

tinnitus2.Drum is retracted or

even perforated.3.Drum may be

intact and show fluid level behind it (hair lines).

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Treatment of BarotraumaTreatment of Barotrauma

Prophylactic treatmentProphylactic treatment::

1) Avoidance of flying with URTI1) Avoidance of flying with URTI

2) During descent chewing gum, 2) During descent chewing gum, always swallow, do Valsalva, do always swallow, do Valsalva, do not sleep “ET are not opened by not sleep “ET are not opened by swallowing during sleep”.swallowing during sleep”.

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Treatment of Barotrauma Treatment of Barotrauma (cont.)(cont.)

Curative Treatment:Curative Treatment:1-1- Nasal drops & Systemic nasal decongestant Nasal drops & Systemic nasal decongestant2- 2- Antibiotics.Antibiotics.3-3- Inflation of Eustachian tube “ there is 3 Inflation of Eustachian tube “ there is 3

methods“methods“ a) a) ValsalvaValsalva method. method. b) b) Politzer’sPolitzer’s method. method. c)c) Catheter Catheter method (Eustachian method (Eustachian

Catheterization). Catheterization). 4-4- If Fluid is present do If Fluid is present do myringotomymyringotomy..

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Disease of the Middle Ear Disease of the Middle Ear Congenital AnomaliesCongenital Anomalies

1- Middle ear 1- Middle ear AplasiaAplasia (Absent M.E.) (Absent M.E.) it leads to conductive deafness and the only it leads to conductive deafness and the only

treatment is bone conduction hearing aid. treatment is bone conduction hearing aid. 2- 2- Abnormal Ossicles: Abnormal Ossicles: as fused , absent , as fused , absent ,

deformed or fixed ossicles. Clinically it lead deformed or fixed ossicles. Clinically it lead to conductive deafness and treatment to conductive deafness and treatment is by ossiculoplasty operation. is by ossiculoplasty operation.

3- Other anomalies that maybe found during 3- Other anomalies that maybe found during middle ear surgery.middle ear surgery.

a)a) DehiscenceDehiscence in the floor and exposure of in the floor and exposure of Jugular bulbJugular bulb..

b)b) Dehiscence of the bony Dehiscence of the bony FacialFacial Nerve Nerve CanalCanal (about 20 %) of the population and other (about 20 %) of the population and other anomalies in the course of facial nerve.anomalies in the course of facial nerve.

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Trauma to the Middle EarTrauma to the Middle Ear

1- Otitic 1- Otitic BarotraumaBarotrauma. .

2- 2- OssicularOssicular disconnection. disconnection.

3- 3- FractureFracture of temporal bone. of temporal bone.

4- 4- F. B.F. B. in middle ear in middle ear

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Fractures of Temporal BoneFractures of Temporal Bone

It is type of Fracture base of skull It is type of Fracture base of skull (middle cranial fossa) (middle cranial fossa)

Types:Types: 1 - 1 - Longitudinal Fracture Longitudinal Fracture 2 - 2 - Transverse FractureTransverse Fracture

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1)Longitudinal Fracture of 1)Longitudinal Fracture of Temporal BoneTemporal Bone

It is the common type It is the common type (80%).(80%). Fracture line is in long axis of temporal boneFracture line is in long axis of temporal bone It involves the It involves the tympanic cavity , tympanic tympanic cavity , tympanic

membranemembrane and and bonybony external canal. external canal.

Clinical Picture:Clinical Picture:

- Conductive deafness. - Conductive deafness.

- Bleeding through ruptured D.M. and may be - Bleeding through ruptured D.M. and may be CSF otorrhoea.CSF otorrhoea.

- Facial N. paralysis is uncommon and partial.- Facial N. paralysis is uncommon and partial.

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2- Transverse Fracture of 2- Transverse Fracture of Temporal BoneTemporal Bone

It is the less common type It is the less common type (20%).(20%). Fracture line is at right angle to the long Fracture line is at right angle to the long

axis of temporal bone. axis of temporal bone. It involves the It involves the labyrinthlabyrinth and or and or internal internal

auditory meatus.auditory meatus. Clinical Picture:Clinical Picture: - Perceptive deafness (S.N.H.L.).- Perceptive deafness (S.N.H.L.). - Vertigo & Nystagmus.- Vertigo & Nystagmus. - Haemotympanum which may contain - Haemotympanum which may contain

also CSF. also CSF. - Facial N. paralysis is more common - Facial N. paralysis is more common

and more severe. and more severe.

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Fracture of Temporal BoneFracture of Temporal Bone (cont.)(cont.)

Investigations:Investigations:

1- 1- C.T.C.T. scan to assess the fracture scan to assess the fracture line. line.

2- 2- AudiologicalAudiological tests to assess : tests to assess :

-Type and degree of deafness. -Type and degree of deafness.

- Stapedial reflex .- Stapedial reflex .

3-Tests for 3-Tests for Facial nerve Facial nerve function.function.

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Fracture of Temporal Bone Fracture of Temporal Bone TreatmentTreatment

1- 1- Neurosurgical treatmentNeurosurgical treatment of the patient (for any of the patient (for any associated coma or extradural haemorlrage,….)associated coma or extradural haemorlrage,….)

2- If 2- If CSF OtorrhoeaCSF Otorrhoea - Prophylactic antibiotics (that cross the blood - Prophylactic antibiotics (that cross the blood brain barrier). - Semi brain barrier). - Semi

sitting position and avoid straining. - Sterile ear sitting position and avoid straining. - Sterile ear dressing. -dressing. -Neurosurgical repair by fascia late for some cases. Neurosurgical repair by fascia late for some cases.

3- 3- Facial Nerve paralysisFacial Nerve paralysis if incomplete and delayed if incomplete and delayed usually recovers spontaneously but if severe and usually recovers spontaneously but if severe and immediate ( indicating severe nerve injury ) do immediate ( indicating severe nerve injury ) do surgical exploration and nerve suture or graft. surgical exploration and nerve suture or graft.

4-Treatment of 4-Treatment of Traumatic Rupture of D.M.Traumatic Rupture of D.M. & Ossicles. & Ossicles.

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