Emergency Medicine

TRAUMATIC CONDITIONS OF THE EAR

ENT emergencies 397

3 Do not attempt any further manoeuvres if the object is not freed instantly, or
if the patient is uncooperative, as the object may be pushed further in, and
cause extreme pain and eardrum damage.
(i) Refer the patient to the next ENT clinic.

Perforated eardrum

DIAGNOSIS

1 The eardrum may be perforated by direct injury from a sharp object, such as
a hairpin, or indirectly by pressure from a slap, blast injury, scuba diving, or
from a fracture of the base of the skull (see below).

2 There is pain, conductive deafness and sometimes bleeding.

3 Suspect inner ear involvement if there is tinnitus, vertigo or complete
hearing loss.

MANAGEMENT

1 Refer the patient immediately to the ENT team if inner ear damage is
suspected.

2 Otherwise, do not put anything into the ear or attempt to clean it out. Advise
the patient to keep water out of the ear canal.

3 Give an antibiotic such as amoxycillin 500 mg orally t.d.s., and refer the
patient to the next ENT clinic.

Basal skull fracture

Most basal skull fractures (see also p. 31) involve the temporal bone. Fractures
may be divided into tympanic bone fractures, longitudinal fractures and trans-
verse fractures.

DIAGNOSIS

1 The temporal bone forms the glenoid fossa of the temporomandibular joint,
and is damaged if the mandibular condyle is driven upwards into the middle
ear or externa l auditor y cana l, causing bleeding or laceration of t he cana l.

2 Alternatively, a longitudinal fracture of the temporal bone will tear the
eardrum and cause dislocation of the ossicular chain, with conductive
deafness, haemotympanum and cerebrospinal f luid (CSF) leakage.
(i) Occasionally, delayed facial nerve damage is seen.

3 A transverse fracture of the temporal bone results in complete sensorineural
deafness associated with tinnitus, vertigo and nystagmus.
(i) Facial nerve palsy is more common than with longitudinal
fractures.

4 Do not insert an auriscope to examine obvious bleeding from the external
auditory meatus, as infection may then be introduced.