Pathology of bone and stone ear injuries

2021-01-31 12:00 AM

Stone fracture injuries are dangerous because of complications of the ear and can cause: meningitis after many years

Injury due to fire, crushing hard object (traffic accident, work accident) due to pressure, pressure, sudden increase or drop of pressure.

Prolonged sound trauma (causes microscopic damage to the cochlea).

 

Broken stone

Characteristics

The stone bone is located deep in the skull, so it is usually a closed injury, but can be accessed through the ear canal.

Stone bone fracture injury is dangerous because of complications of the ear and can cause such as meningitis after many years because the broken path only has fibrous organizations heal, not the bone can because the stone bone does not form. osteoblasts.

Before a traumatic fracture, it is necessary to first examine the cranial nerve to detect the epidural hematoma. The sequelae of bone fracture and traumatic brain injury to the ear are quite complex, not only with auditory function, balance but also in psychology and sympathetic nerves.

Reason

Due to falls, car accident, labour accident, head hit on the wall, machine ...

Due to being hit with a hard object into the occipital region, temporal temple, sometimes the skull is broken.

Symptom

Ear bleeding: blood oozing or stagnation in the outer ear canal, red blood, a clot found in the vertical rupture.

Cerebrospinal fluid flow: clear fluid flows a lot, oozes or drips from the deep of the ear canal, in the ear canal, can last 5-7 days, not-self. Cerebrospinal fluid may be drained with blood, the posterior pink fluid gradually fades. Meet in the cross break and cross break. If in doubt, bring test solution, if there is glucose, it is cerebrospinal fluid.

Relay hearing loss due to damage to the cochlea, if the mixed hearing loss gradually decreases due to atrial concussion: accompanied by hearing loss with tinnitus.

Dizziness: can be severe, accompanied by an imbalance with jerky eyeballs.

Examination of the ear and the mastoid region can be seen: a bruise in the mastoid area, which appears a few days after trauma, must be thought of a diagonal rupture. The ear canal is torn from the skin, bleeding, the eardrum is swollen, purple-green in colour due to the bleeding in the ear canal, a vertical rupture is thought of. The ear canal is torn skin, bleeding occurs in cross rupture and vertical rupture.

Marked peripheral facial paralysis is seen in a transverse fracture or semi-paralysis seen in cross fracture.

Diagnose

Understand the mechanism of injury.

The situation of injury such as from a fall, being beaten ...

Place of injury, on the skull of the temporal region, occipital, cymbals ...

The clinical symptoms depend on the bone fracture line.

When in doubt a cross or cross break should:

Cerebrospinal fluid puncture: cerebrospinal fluid is pink; a lot of erythrocytes are detected due to meningeal tear.

Stenver or Chaussé III (nowadays CT Scan) posture X-ray can reveal fracture line in rock bone.

Note: Symptoms such as mixed hearing loss, moderate, mild and gradual dizziness appeared after injury, no physical damage to the ears, mastoid bone, no bleeding or cerebrospinal fluid. , think of atrial concussion.

Progression and complications

Atrial shock: can be cured after rest, anti-inflammatory.

Stone bone fracture without cerebrospinal fluid: can resolve on its own. If there is a tear, damage to the eardrum susceptible to otitis media, mastoiditis.

Stone bone fracture with the cerebrospinal fluid flow: easily leads to diffuse meningitis. With the rupture line across the inner ear canal, the labyrinth causes hearing loss, and facial paralysis is usually irreversible.

Treatment

Bleeding from the ear: clean the ear canal and place the antibiotic wick.

Cerebrospinal fluid to the ear (sometimes to the nose and throat): clean the ear canal, then place the antibiotic wick, a sterile bandage. Avoid causing infection from outside.

Using antibiotics against meningitis, monitoring cerebrospinal fluid.

If mastitis is present, mastoid surgery is required.

If there is atrial labyrinthitis need to drill and drain the atrium.

Ear injury due to pressure

Reason

Due to explosive waves (bombs, grenades, artillery ...).

Damage to the middle ear: tearing of the eardrum, dislocation of the anvil.

Damage to the inner ear such as bleeding, damage to the cells of the Corti organ.

Symptom

A throbbing pain in the ear, usually lasting a few days, can turn into deep pain in the ear.

Hearing loss: right after the injury, the patient has mild, moderate, severe hearing loss depending on the injury. Usually tapered but may not be reversible.

Tinnitus: The buzzing that is frequently present in the ears fades away after a few days.

Dizziness appears immediately after injury along with hearing loss. Then the tinnitus can last continuously.

Ear exam: the eardrum may tear, bleed, and become slightly burdened.

Diagnose

A history of stress injuries.

Symptoms appeared after the injury.

Audiometry: can be transmissible hearing loss, if there is a dislocation of the child can lose up to 60dB. If there is damage to the inner ear there is hearing loss.

Evolution

When there is a tearing of the eardrum, it is easy to get otitis media and mastitis.

Treatment

When the eardrum is torn: wipe the ear canal and place the antibiotic wick.

Watch for otitis media and mastitis.

Vitamins group A, B and rest.

Ear wound

The trajectory of the bullet wound is very complicated because the ear itself has a complex anatomy, so it has to be examined carefully.

Treatment

During the first hour of the spot: try to wipe the ear area, around the ear clean, wash the ear canal with sterile water, then sprinkle with antibiotic powder.

If shocked must be shocked first.

Study carefully the path of the shrapnel, assess the wound, assess the damage.

Purpose of surgery

Get foreign bodies.

Releasing pressure causes such as blood clots, foreign bodies, crushed bones.

Prevent and treat bacterial infections.

Surgical methods

If the shrapnel is in the ear canal, cut the line behind the ear, go from back to front to check.

Middle ear wound: surgery on the ear canal for drainage.

Stone bone wound: expand and remove all foreign objects to prevent labyrinth complications.

In the mastoid bone: dissection of the mastoid bone.

Note: there are cases where the wound causes bleeding due to damage to the large artery wall. Or shrapnel plugged into the lateral venous sinus, when handling the fragment, would cause massive bleeding.

Symptoms

Impacts on hearing function: conductive hearing loss or irreversible reception deafness.

Distortion of the ear rim, the ear canal.

Temporomandibular joints stick together.

Nerve paralysis.