Otologic Trauma

Temporal Bone Fractures - Skull's Ear Shield Cracks

• Petrous temporal bone fractures due to head trauma.
• Types & Features:
  • Longitudinal (~80%):
    • Cause: Temporal/parietal blow.
    • Line: Parallel to petrous axis.
    • Signs: Otorrhagia, TM perforation, CHL (ossicular damage).
    • Facial palsy: ~20% (delayed, good prognosis).
    • Other: CSF otorrhea, Battle's sign (postauricular ecchymosis).
  • Transverse (~20%):
    • Cause: Frontal/occipital blow.
    • Line: Perpendicular to petrous axis.
    • Signs: Hemotympanum (TM intact), SNHL (cochlear/vestibular damage), vertigo.
    • Facial palsy: ~50% (immediate, poorer prognosis).
    • Other: CSF otorrhea (less common).
  • Mixed: Combined features of longitudinal and transverse.
• Diagnosis: HRCT temporal bone is gold standard.
• Key Complications: Hearing loss (CHL/SNHL), facial nerve palsy, CSF leak (otorrhea/rhinorrhea), meningitis, vertigo.

⭐ Transverse fractures, though less common (20%), carry a higher risk (50%) of immediate, severe facial nerve injury and profound sensorineural hearing loss (SNHL).

Auricle & Canal Injuries - Outer Ear Insults

• Auricular Hematoma (Otohematoma)
  • Blood collection: between perichondrium & cartilage.
  • Pathophysiology: Shearing force → cartilage devascularization → necrosis → "Cauliflower ear" deformity.
  • Treatment: Prompt Aspiration/Incision & Drainage (I&D) + pressure dressing (e.g., button bolsters) + prophylactic antibiotics.
  • Complication: Perichondritis.

  ⭐ Failure to adequately drain an auricular hematoma within 7-10 days leads to irreversible cauliflower ear deformity due to cartilage necrosis and fibrocartilage formation.

• Auricular Lacerations/Avulsion
  • Management: Meticulous cleaning, debridement, preserve cartilage.
  • Repair: Layered closure; skin first, then perichondrium. Skin grafts/flaps for large defects. Tetanus prophylaxis.
• External Auditory Canal (EAC) Trauma
  • Common Causes: Self-inflicted (e.g., Q-tips), foreign bodies, iatrogenic injury.
  • Symptoms: Pain (otalgia), bleeding (otorrhagia), Conductive Hearing Loss (CHL).
  • Management: Gentle cleaning, topical antibiotic/steroid drops. Avoid water entry. Risk of canal stenosis if severe.
• Frostbite/Burns (Auricle)
  • Auricle highly susceptible due to exposed location & limited subcutaneous tissue.
  • Frostbite: Rapid rewarming (e.g., warm water at 38-42°C); analgesia. Avoid rubbing.
  • Burns: Topical antimicrobials (e.g., silver sulfadiazine); debridement as needed. Consider chondritis risk.

Middle Ear Mayhem - Drum & Bones Drama

• Tympanic Membrane (TM) Perforation:

  • Causes: Direct (Q-tip), indirect (slap, blast), barotrauma.
  • Symptoms: Sudden pain, ↓ hearing (CHL), tinnitus, otorrhea (bloody/clear).
  • Signs: Visible tear. Weber → affected ear.
  • Management:
    • Most heal (~90% in 3 months).
    • Keep ear dry. Antibiotics if infected.
    • Myringoplasty if persistent.
  • 

  • ⭐ Blast injuries: often irregular, multiple TM perforations; risk of higher CHL or mixed hearing loss.

• Ossicular Disruption (Dislocation/Fracture):

  • Causes: Temporal bone #, direct trauma, severe barotrauma.
  • Most common: Incudostapedial joint separation, incus dislocation. 📌 "Incus is Insecure".
  • Symptoms: Max CHL (~60 dB), hemotympanum.
  • Management: Ossiculoplasty (PORP/TORP) for persistent significant CHL.

• Hemotympanum:

  • Blood behind intact TM.
  • Causes: Temporal bone #, barotrauma.
  • Usually resolves; myringotomy if persistent.

Inner Ear & Pressure Trauma - Deep Ear Damage

• Direct Inner Ear Injury:
  • Causes: Temporal bone # (esp. transverse), penetrating trauma.
  • Results: Profound SNHL, severe vertigo, tinnitus. Facial nerve palsy common with transverse #.
• Barotrauma (Pressure Injury):
  • Perilymphatic Fistula (PLF):
    • Rupture: Round/oval window (e.g., diving, flying, Valsalva, blast).
    • Symptoms: Sudden/fluctuating SNHL, vertigo, tinnitus.
    • Signs: Hennebert's (pressure-induced vertigo), Tullio's (sound-induced vertigo).
    • Tx: Conservative (bed rest, head elevation, avoid straining); surgical repair for persistent cases.
  • Inner Ear Decompression Sickness (IEDCS):
    • Divers: Nitrogen bubbles in inner ear.
    • Symptoms: Acute vertigo, SNHL. Tx: Recompression therapy.

⭐ Hennebert's sign (nystagmus/vertigo on EAC pressure change) can indicate a perilymphatic fistula or Meniere's disease (especially syphilitic labyrinthitis).

High‑Yield Points - ⚡ Biggest Takeaways

• Temporal bone fractures: Longitudinal (commoner, CHL, facial palsy ~20%) vs. Transverse (SNHL, vertigo, facial palsy ~50%).
• Basilar skull fracture signs include Battle's sign, Raccoon eyes, and CSF otorrhea.
• Hemotympanum (blood in middle ear) and ossicular disruption (incus common) cause conductive hearing loss.
• Perilymphatic fistula presents with episodic vertigo and/or fluctuating SNHL post-trauma.
• Barotrauma affects the middle ear during pressure changes; acoustic trauma causes SNHL, often with a 4 kHz notch.