Ear Injuries and Trauma
Trauma to the ear and temporal bone (ear canal, ear drum, middle ear bones, inner ear) can result in different types of injury. Here are a few:
An auricular hematoma occurs when a pocket of blood collects under the skin of the outer ear. This causes the outer ear to look swollen. The pocket of blood will feel soft, like a water balloon. If diagnosed early, treatment typically involves opening the pocket and draining the blood. A bolster dressing is often placed to prevent the blood from re-accumulating.
Tympanic membrane perforation (Ear drum rupture)
The ear drum can rupture when foreign objects pierce it through the ear canal, with rapid pressure changes to the ear, or with blunt force trauma to the temporal bone. Many traumatic ear drum ruptures heal on their own without the need for surgery. Others can predispose to infection and require treatment with antibiotic ear drops or pills. Some perforations do not heal on their own or can cause cholesteatoma to form. In these cases, an ear specialist may recommend surgery.
Temporal bone fracture
The temporal bone is one of the many bones that make up the skull. In head trauma, this bone can become fractured, and is diagnosed using a CT scan. Temporal bone fractures can potentially cause complications including hearing loss, dizziness, facial paralysis, or leaking of cerebrospinal fluid (CSF). The associated hearing loss can result from blood building up behind the ear drum, from ear drum rupture, from dislocation of the middle ear hearing bones, or from fracture through the inner ear. The first three causes of hearing loss result in a conductive hearing loss while fracture through the inner ear causes a sensorineural hearing loss.
Facial paralysis can occur when the facial nerve is cut or swollen due to head injury. If the facial paralysis occurs immediately with the temporal bone fracture, sometimes surgery may be helpful to repair a cut nerve. This decision is often based on the specific anatomy seen on the patient's CT scan. If the facial paralysis occurs on a delayed basis (hours or days after injury) then often the nerve is swollen and not fully cut, and conservative management without surgery is recommended.
CSF leak can occur after temporal bone fracture since the "ceiling of the ear" shares the same bone as the "floor of the brain". This can manifest as dripping of thin clear fluid from the ear, or out of the nose. Many CSF leaks heal on their own. Some patients require a lumbar drain, which is a tube that decompresses the CSF through the back. Less commonly, patients may require surgery to repair the CSF leak.
Ossicular dislocation occurs when the three middle ear hearing bones (malleus, incus, stapes) are no longer in continuity. This results in a conductive hearing loss. This can occur after either blunt or penetrating trauma to the ear. For some patients, surgery can be performed to reconstruct the hearing bones. In other patients, a hearing aid may be considered.