Ear Emergencies

Question 1

What is a pinna haematoma?

Answer 1

blunt trauma may cause bleeding in the subperichondrial plane elevating the perichondrium to form a haematoma

Question 2

What is the treatment of pinna haematoma?

Answer 2

aspirate or incision and drainage

pressure dressing to prevent reaccumulation

Question 3

What is the management of an ear laceration?

Answer 3

debridement
closure - primary, reconstruction - usually under local anaesthetic
antibiotics

Question 4

What should you ask in the history of a suspected temporal bone fractures?

Answer 4

injury mechanism 
hearing loss 
facial palsy 
vertigo 
CSF leak 
associated injuries 
Loss of consciousness

Question 5

What should you look for in the examination of a temporal bone fracture?

Answer 5

bruising 
battle sign 
condition of tympanic membrane and ear canal 
CN VIII 
hearing test

Question 6

What is a battle sign?

Answer 6

bruising over the mastoid process
takes one day to appear
indicates fracture at base of skull

Question 7

What are the characteristics of a longitudinal temporal bone fracture?

Answer 7

fracture line parallel to the long access of the petrous pyramid
otic capsule spared

Question 8

What are the clinical features of a longitudinal temporal bone fracture?

Answer 8

bleeding from the external canal due to laceration of skin and ear drum 
haemotympanum 
ossicular chain disruption 
facial palsy 
CSF otorrhoea

Question 9

What is haemotympanum?

Answer 9

presence of blood in the tympanic cavity of the middle ear

Question 10

What can cause conductive deafness in a longitudinal temporal bone fracture?

Answer 10

haemotympanum

ossicular chain disruption

Question 11

What can cause a longitudinal fracture of the temporal bone?

Answer 11

lateral blow

Question 12

What can cause a transverse temporal bone fracture?

Answer 12

frontal blow

Question 13

What are the characteristics of a transverse temporal bone fracture?

Answer 13

fracture at right angles to the long axis of the petrous pyramid
can cross internal acoustic meatus causing damage to auditory and facial nerves
otic capsule involved

Question 14

What are the clinical features of a transverse temporal bone fracture?

Answer 14

sensorineural hearing loss due to CN VIII damage
facial nerve palsy (50%)
vertigo

Question 15

What is the otic capsule?

Answer 15

dense osseous labyrinth of the inner ear that surrounds the cochlea, vestibular and semi-circular canals

Question 16

What is the management of temporal bone fractures?

Answer 16

may need facial nerve decompression if no recovery and indicated by EMG studies
may need to manage CSF leak if it doesn’t settle
may need hearing restoration - hearing aid or ossiculoplasty

Question 17

What is the treatment for sudden sensorineural hearing loss?

Answer 17

steroids

urgent ENT referral

Question 18

What is the management of foreign bodies in the ear?

Answer 18

can usually wait until urgent clinic for removal
remove watch batteries immediately
drown live animals with oil and remove the next day

Question 19

What are the 5 parts of the temporal bone?

Answer 19

Mastoid 
Styloid process 
Tympanic bone 
Squamous part 
Petrous part

Question 20

What is otitis externa in diabetics treated with and why?

Answer 20

ciprofloxacin - cover Pseudomonas - prophylaxis of malignant/necrotising OE