What could be done to manage a bullet shot in the ear?

Question

Hi doctor,

My family relative got shot yesterday. As of right now, he still has the bullet inside. The bullet went in through his left ear and did not come back out. I am not sure exactly where inside the bullet is. He is currently hospitalized, but no doctor has come up with a solution. My relative is in severe pain to the point where he starts to shake. I would like a second opinion and want to know what a doctor would do.

Answer 1

Hi,

Welcome to icliniq.com. In penetrating bullet injury, CT scan of the head should be obtained after stabilizing his cardiopulmonary condition to determine the extent of intracranial damage and the presence of intracranial metallic fragments (bullet). I would also suggest you to carry out computed tomographic angiography (CTA) for the evaluation of intracranial and extracranial vessels. MRI cannot be performed here, since the bullet is still inside the brain. Now coming to the surgery part, in most cases, removal of a deep-seated bullet is not necessary since the risk of brain injury from the retrieval of the bullet exceeds the benefit of its removal. However, depending upon the expertise, position of the bullet that is accessibility, etc., computer-image guided procedures for the removal of bullet fragments may be tried.