Sports Medicine: Just the Facts

CHAPTER 29 • OTORHINOLARYNGOLOGY 167

contusions to the pinna. This can evolve into a perma-

nent cosmetic deformity with chronic hematomas,

secondary to an increased pressure and eventual

necrosis of the pinna and cartilage.

• Signs and symptoms:Acute throbbing pain, tender-
  ness and edema


• Examination:Soft hematoma within the auricle


• Treatment: Recommended treatment is ice and
  prompt aspiration with an 18–20-gauge needle using
  sterile technique, prophylactic antibiotics, and pres-
  sure dressing (collodium splint or tie through suture
  with dental row or button). Compression prevents
  hematoma from reforming and should be left in place
  for 7–10 days. The athlete should not return to play
  until after the removal of the compression device,
  and should always wear proper ear protection (head
  gear).
  •An alternative treatment method is repeated aspiration
  of the hematoma. This allows the athlete to return to
  play quickly (same day with head gear); however, this
  treatment method usually leads to a permanent cauli-
  flower ear. Both the athlete and the parents should be
  informed of the risk and the permanence of this defect
  (Swinson and Lloyd, 2003).

OTITIS EXTERNA

• Infection of the external auditory canal is most com-
  monly caused by Pseudomonas spp., Proteus spp.,
  E. coli, or fungi. It is mostly seen in water sports and
  has an increased incidence in poorly chlorinated pools
  and fresh water.


• Signs and symptoms:Pain with movement of the
  auricle is the classic finding with or without a watery
  discharge and/or a mild hearing loss.


• Examination:Erythematous and edematous auditory
  canal with a normal or mildly erythematous tympanic
  membrane. Fungal infections typically have a white to
  gray appearance with spots that resemble cheese, and
  pseudomonal infections will usually have a sweet
  odor.


• Treatment:Irrigating the canal allows the medication
  to enter the canal. Cortisporin otic suspension (solu-
  tion if the tympanic membrane(TM) is perforated)
  should be applied (5 drops in the ear qid) for 7 days.
  If the canal is swollen, a cotton wick may be used to
  help deliver the antibiotic. Tolnaftate drops applied
  twice a day for 7 days is the drug of choice for most
  fungal infections. Swimmers will use a mixture of
  50% white vinegar and 50% rubbing alcohol after
  swimming and showering to prevent this from occur-
  ring (Blanda and Gallo, 2003).

TYMPANIC MEMBRANE RUPTURE

• This usually occurs secondary to a diving, water
  skiing, surfing, or slap injury.


• Signs and symptoms:Acute pain, sudden unilateral
  hearing loss, nausea, and vertigo.


• Examination:Visualization of the defect with an oto-
  scope.


• Treatment: Observation and reassurance are the
  treatments of choice, as 90% will heal in 8 weeks.
  Antibiotic otic drops are recommended when an
  infection develops or the injury occurred in water
  sports. Hearing tests are recommended if greater than
  25% of the TM is involved to rule out nerve injury
  (Blanda and Gallo, 2003).

NASAL INJURIES

NASAL FRACTURES

• Most common sports-related facial fracture as well as
  the most common facial structure injured. Direct end-
  on blows usually result in comminuted fractures of
  both the bone and the cartilage. Side blows usually
  result in simple fractures with deviation to the opposite
  side.


• Signs and symptoms:Acute pain, tearing, epistaxis,
  facial swelling, and ecchymosis.


• Examination: Crepitus over the nasal bridge and
  observation of nasal deformity. If bleeding is present
  a ring test should be performed.


• X-rays:Seldom helpful for treatment decisions in the
  clinic or emergency room, but may be useful in docu-
  mentation.


• Treatment:If done immediately, reduction of the dis-
  placed nasal fracture is semipainless. Swelling makes
  adequate assessment of nasal deformity difficult. If
  unable to reduce an otorhinolaryngology referral is
  required in 5–7 days for reduction. Athletes should not
  return to play the same day unless there are absolutely
  no other associated injuries and the nose can be pro-
  tected. Return to play is typically not advised for at least
  the first week postreduction. External protective devices
  are recommended for the first 4 weeks postinjury.

SEPTAL HEMATOMA

• This is an accumulation of blood between the septal
  cartilage and the overlying mucoperichondrium.
  Septal hematomas are prone to abscess formation,
  leading to pressure necrosis of the underlying bone
  and cartilage (saddle nose deformity) if not treated.