Introduction
Trauma to the face or head can damage any part of the ear, including the middle and inner ear. Road traffic accidents, loud noises, penetrating injuries, changes in pressure, and trauma from contact sports can lead to a middle ear injury. It can result in ear pain, dizziness, infections, and hearing loss.
What Are the Parts of the Middle Ear?
The human ear is divided into the outer ear, middle ear, and inner ear. The middle ear is also called the tympanic cavity. The tympanic membrane, called the eardrum, separates the outer ear from the middle ear. In addition, the middle ear consists of three major ear ossicles: malleus, incus, and stapes.
What Are Middle Ear Injuries?
Accidents, loud noises, pressure variations, or the presence of foreign objects in the ear can cause injury to the eardrum or cause fracture or dislocation of the ear ossicles. In addition, the middle ear is exposed to blunt and penetrating trauma and thermal and blast injuries.
What Are the Causes of Middle Ear Injury?
- Accidents and Injuries: Trauma from a car accident, sports injuries, or a blow to the head can cause a middle ear injury.
- Fracture: Bones in the middle ear can fracture due to serious accidents, dislocation, and fractures in the jaw and face.
- Presence of Foreign Object: Most commonly seen in children, pencils, toys, cotton swabs, or other objects introduced too far into the middle ear can break, split, or tear the eardrum.
- Pressure Variations: Increased pressure variations experienced while flying in an airplane or during scuba diving can cause eardrum rupture.
- Loud Noise: Loud noises such as fire explosions, gunshots, and loud noise from loudspeakers can cause a tear in the ear drum. Long-term exposure to this loud noise can cause permanent hearing loss.
What Are the Types of Middle Ear Injuries?
- Tympanic membrane or ear drum perforation.
- Middle ear hemorrhage.
- Fracture of ear ossicles (malleus, incus, and stapes).
- Dislocation of ear ossicles.
- Perilymphatic fistula.
- Damage to the facial nerve.
What Are the Symptoms of Middle Ear Injury?
- Dizziness.
- Loss of equilibrium.
- Bleeding from the ear.
- Pus from the ear.
- Hearing loss.
- Headache.
- Pus from the ear.
- Dizziness.
How Are Middle Ear Injuries Evaluated?
In the case of serious trauma or injury to the head and face region, the patient is carefully examined to rule out ear injuries. Primary care is given in high-risk and unstable patients, and ear injuries should be part of secondary observation. Contaminated injuries were considered infection-prone and at a high risk of developing tetanus. Tetanus is a rare but serious condition that can be fatal if left untreated. The bacteria that cause tetanus is commonly found in soil or manure and enters our body through a cut or wound. Tetanus prophylaxis is given to reduce the risk of the infection.
The presence of a foreign body found in the ear should be left in place and carefully removed under controlled conditions by a specialist doctor. An otolaryngologist should remove foreign objects in the middle ear under a microscope. In a closed head injury or direct ear trauma, the clinician should ask for symptoms like ear pain, hearing loss, vertigo, imbalance, and tinnitus. An otolaryngologist should do a physical examination.
Blood clots, if present in the ear canal, are removed carefully. An autoscopy of the external canal, tympanic membrane, middle ear, and internal ear is done. Pneumatic otoscopy is done in patients with tympanic membrane perforation. In this procedure, an otoscope is used to assess the tympanic membrane and middle ear.In hearing loss assessment, a behavioral test is done in active patients, and auditory brainstem response is carried out for passive and uncooperative patients. A pure tone audiometry test is done for further diagnosis in patients above four years of age. Cerebrospinal fluid (CSF) in the ear or nasal secretion should be considered (CSF Otorrhea).
Computed tomography (CT) of the temporal bone was carried out in the following situations.
- Head or middle ear trauma with peripheral facial nerve paralysis.
- Blunt or penetrating middle ear injury.
- Basilar skull fracture.
- Better evaluation of blood-covered structures in the hemotympanum.
- Ear or nose drainage of cerebrospinal fluid (CSF).
How Is the Facial Nerve Affected in the Middle Ear Injury?
The facial nerve exits the internal auditory meatus, crosses the middle ear, and divides to form its branches. Facial nerve damage may arise from direct trauma to the middle error with a basilar skull fracture. The facial nerve injury causes facial paralysis on the same affected side and a metallic taste on the tongue. In addition, patients with facial nerve paralysis show drooping of the face on one side, drooling of saliva, headache, difficulty chewing, and facial asymmetry.
How Are Middle Ear Injuries Managed?
Several external factors can cause injury to the middle ear, which are not uncommon. Before treating middle ear injuries, penetrating drama should be distinguished from non-penetrating trauma. The trauma is again classified based on the cause of the trauma. They are divided into pressure trauma, blast injury, thermal, electric, and caustic trauma.
1. Management of Tympanic Membrane:
- Simple perforations of the tympanic membrane without inner ear injuries can be treated conservatively.
- Antibiotic ear drops are given in the initial phase.
- Oral antibiotics and steroid drops can be based on the amount of middle ear inflammation.
- Continuous clinical examinations are carried out till complete healing of the membrane is completed.
- If the perforations persist after three to six months, with proper medication and follow-up, surgical correction will occur.
- Pressure injuries show a better healing rate than water pressure, corrosive or thermal damage.
- Caustic injuries to the middle ear can result in chronic myringitis. Chronic myringitis can be defined as the rupture of the tympanic membrane for more than a month without any disease or infection in the middle ear cavity.
- Caustic injuries require combined antibiotics and steroid ear drops to be used for several weeks.
- Oral antibiotics can be prescribed as an adjunct.
- After the inflammation has subsided, consider surgical correction.
2. Tympanoplasty:
- It is a microsurgical procedure to fix the ear drum's perforations, which are not healed by initial therapy. The placement treats the perforated tympanic membrane of a graft. This procedure aims to treat the perforation of the eardrum and restore hearing ability. It is a safe and effective procedure with a success rate.
3. Management of Ear Ossicle:
- The most common dislocation in the ossicular chain is seen in the incudostapedial joint.
- A post-traumatic ossicular dislocation should be observed for at least three months before proceeding to surgical correction.
- If it persists after three months, conventional amplification or ossiculoplasty is to be done. Ossiculoplasty is a surgical procedure in which the dislocated ear ossicles are replaced to improve hearing ability.
- The reconstructed bones are artificial bones made of cartilage, titanium, or plastic.
How Can Ear Injuries Be Prevented?
- Avoid frequent exposure to loud noise, and consider wearing ear protection.
- While flying on an airplane, use special earplugs to reduce the pressure variation.
- Listening to earphones in a lower voice.
- Use of a helmet while riding a bike or on a skateboard.
- Use protective headgear in sports like boxing and wrestling.
- Avoid using sharp objects in the ear.
- Keep sharp and tiny objects away from children and avoid putting them in the ear.
Conclusion
Ear Injuries can be minor self-healing injuries to life-threatening ones. All possible chances that cause an injury or trauma should be avoided. If there is an ear injury, consider consulting a specialist at the earliest. Kids tend to put sharp and tiny objects into their ears, always keeping these objects away from them. Never put anything into the ear to prevent ear injuries, and avoid listening to music at a high volume. Wear protective headgear while riding and in sports.
