ME Disorders (Trauma)

Question 1

what is some etiology to trauma

Answer 1

Blow to the side of the head/falls
Sports injuries such as in racquet ball, football, boxing
Blast injuries (e.g., bombs/improvised explosive device – IEDs)
Motor vehicular accidents
Foreign body insertion such as Q-tips (ossicular disarticulation)

Question 2

In cases of head trauma, the inner ear may be involved too resulting in SNHL with accompanying ME damage such as

Answer 2

™ perforation
ossicular disarticulation
hemotympanum (blood in the tympanic cavity)

Question 3

how do you get disarticulation with Q tips

Answer 3

they are long and thin, happens if you shove it in too far and can result in a dead ear

Question 4

etiology of ossicular disarticulation

Answer 4

Trauma to the head or face
Also seen in medical conditions such as osteoporosis
In cases of cholesteatoma where the pseudo-tumor can destroy the ossicles
Untreated ME infection that can destroy the ossicles

Question 5

normal appearance of the middle ear ossicles on axial CT scan

Answer 5

ice cream cone

Question 6

The ball of the ice cream is formed by the head of the _____ and cone is formed by the body of the ____, with the tapering conical point formed by the short process of the____

Answer 6

malleus, incus, incus

Question 7

Failure of this normal configuration suggests ossicular chain disruption (incudomalleolar disarticulation)

Answer 7

ball of ice cream fell off

Question 8

otoscopy findings of ossicular disarticulation

Answer 8

Depending on the cause of the disarticulation
Perforation of TM
Bleeding in the ear canal with TM perforation
Rarely, the TM and ear canal may appear normal

Question 9

immitance results of ossicular disarticulation

Answer 9

Jerger type Ad tympanogram
Abnormal reflexes

Question 10

pure tone results of ossicular disarticulation

Answer 10

conductive/mixed hl

Question 11

treatment of ossicular disarticulation

Answer 11

Surgical repair
Amplification, if surgery is not successful/not an option

Question 12

Majority of temporal bone injuries occur as part of multiple injuries following motor vehicular accidents (MVA)

Answer 12

true

Question 13

temporal bone trauma is caused by

Answer 13

Industrial accidents
Recreational injuries
Falls
Assaults
Gunshot wounds
Self-inflicted injuries

Question 14

temporal bone fractures occurs in ______% of head injuries

Answer 14

30-75%

Question 15

types of temporal bone trauma

Answer 15

a. trauma with fracture

b. trauma without fracture

Question 16

type a trauma with fracute
Longitudinal fractures

Answer 16

direct blow to temporal/parietal aspect)
Most common fractures of the temporal bone (70 to 90%)
Parallels long axis of the temporal bone in coronal plane
Passes through the postero-superior aspect of the external auditory canal, TM, and roof of ME
Disrupts the ossicles but generally spares the otic capsule

Question 17

transverse fractures

Answer 17

commonly due to a blow to the occiput)
Less common fractures of the temporal bone (20 to 30%)
Extends through internal auditory canal or otic capsule – otic capsule disrupting fracture
Can affect the oval or round window

Question 18

blunt trauma with fracture

Answer 18

Few temporal bone fracture are purely longitudinal or transverse
About 50 to 75% are mixed

Question 19

otic barotraua

Answer 19

Barotrauma refers to injury sustained from failure to equalize the pressure of an air-containing space with that of the surrounding environment such as observed in the ear, face, and lungs
The most common examples of barotrauma occur in air travel and scuba diving
Barotrauma most often occurs during compression (descent) or after a short, shallow dive
Otic barotrauma causes sudden and severe negative ME pressure and trauma to the ear resulting in

Question 20

Inner ear decompression sickness (IEDCS)

Answer 20

most often occurs during decompression (ascent) or shortly after surfacing from a dive
It is an injury that closely resembles inner ear barotrauma, however, the treatment is different
It is more common among commercial and military divers who breathe a compressed mixture of helium and oxygen

Question 21

symptoms of IEDCS

Answer 21

HL & tinnitus
dizziness

Question 22

Patients with IEDCS should be rapidly transported to a

Answer 22

hyperbaric chamber for recompression
Significant correlation between early recompression and recovery

Question 23

thermal injuries

Answer 23

Injuries sustained during welding leading to TM perforation
Lightning bolt conducted through phone or other means

Question 24

symptoms of thermal injuries

Answer 24

SNHL
Dizziness/vertigo
facial paralysis from devitalized bone and soft tissue

Question 25

what are compressive injuries

Answer 25

When slapped or struck on the side of the head Falling on water during water sports Most significant is from blast injuries

Question 26

what can bomb explosions cause

Answer 26

disruption & implosion of ™ HF SNHL due to disruption of the inner ear

Question 27

what are auditory signs of injury

Answer 27

Acute or delayed conductive hearing loss Clotted blood, debris, and hematoma in the ear canal Perforated, lacerated, or completely disrupted TM ME filled with blood or cerebrospinal fluid (CSF) Bleeding from ears; common sign of temporal bone fracture Ossicular disarticulation Ossicular fixation due to fibrous adhesions High incidence of SNHL

Question 28

vestibular symtpoms of injury

Answer 28

Benign paroxysmal positional vertigo (BPPV) Concussive injury to labyrinth resulting in vestibular symptoms Perilymphatic fistula

Question 29

80 to 90% of longitudinal temporal bone fractures result in

Answer 29

facial n paralysis

Question 30

Self healing in 4 to 6 weeks Myringotomy to drain is not recommended; high risk of infection

Answer 30

hemotympanum

Question 31

Self-healing; observe and manage conservatively Make sure perforated edges do not get infected, which may result in cholesteatoma If healthy perforation persists after several months then a myringoplasty can be performed

Answer 31

tm perforation

Question 32

Exploration and repair of ossicles Amplification if surgery is not an option

Answer 32

persistent chl

Question 33

treatment of rreversible SNHL and tinnitus

Answer 33

HA's and tinnitus management

Question 34

vestibular treatment

Answer 34

Mostly self-limiting resolving within 6 months

Question 35

BPPV treatment

Answer 35

Typically self-limiting resolving within 3 months If not resolved then treatment needed i.e., Epley maneuver

Question 36

otitic meningitis treatmet

Answer 36

Meningitis can complicate traumatic encephalocele or CSF leak may occur months or years later with or without CSF leak Treated with antibiotics based on culture results