Trauma to the ear can involve external ear trauma, rupture of the tympanic membrane (eardrum) or acoustic trauma, which represents trauma to the inner ear, usually from exposure to high decibels of sound. The ear is a delicate organ of the body so that injuries from direct trauma or indirect trauma are highly possible following a fall, a motor vehicle accident or even exposure to loud sounds.
External Ear Trauma
The ear can be lacerated if struck with a sharp object or against some glass or another firm surface. The external ear is made up of cartilage and skin; it is shaped the way it is to absorb and direct sound into the external ear canal and finally onto the eardrum.
Trauma to the external ear can lead to disfigurement and to infection if left untreated. Most ear injuries include damage to the skin and underlying cartilage. Doctors can suture the skin in order to approximate what the ear looked like before the injury; however, the cartilage has a notorious reputation for not healing well when sutured due to the poor blood supply. This is why the cartilage is often not sutured so the healing must occur secondarily, without sutures. The good news is that when the cartilage is re-approximated following the injury, the cosmetic outcome is improved.
Ear Drum Rupture
An eardrum rupture occurs when there is a hole in the eardrum, also known as the tympanic membrane. This is a roughly circular piece of tissue that helps transmit sound from the external part of the ear to the inner ear, through its connection to the hearing part of the ear via the stapes, hammer, and anvil. If the eardrum is damaged, you can suffer hearing loss. Motor vehicle accidents with significant head trauma can rupture one or both eardrums. Trauma to the side of the head can especially lead to this problem. Driving at high altitudes will increase the risk of tympanic membrane rupture during a collision because of extra pressure placed upon the tympanic membrane.
Symptoms of tympanic rupture include pain in the affected ear as well as decreased hearing. Blood or fluid can be found in the external canal from spilled middle ear fluid reaching the external canal. Some patients will have tinnitus, which is the sensation of buzzing or ringing in the ear. A weakness of the facial muscles can stem from a severe rupture of the tympanic membrane. The pain can be relieved by local heat to the affected area and ibuprofen, naproxen or acetaminophen, which are available over the counter.
If spontaneous healing from the tympanic membrane rupture does not occur, surgical patching of the TM may have to be undertaken in order to prevent a permanent connection between the external ear canal and the middle ear cavity. During the surgical procedure, a medicated patch is placed over the hole so that spontaneous closure cannot occur. If the middle ear becomes infected, antibiotics in the form of ear drops or oral medication may be indicated.
Rarely, surgery is required to repair a large rupture in the tympanic membrane. This procedure, called a tympanoplasty, involves taking tissue from another body area and placing it as a graft into the hole in the membrane.
Most people recover from a tympanic membrane rupture within eight weeks of injury without any intervention at all. Those who suffer from this condition are encouraged to refrain from blowing their nose as this can increase the pressure within the middle ear cavity, interfering with healing. Cotton balls or other ear plugs are recommended when bathing to prevent bathwater (or pool water) from getting into the middle ear cavity. The ear must be kept clean and dry at all times to avoid secondary infections. In some cases, no swimming at all may be recommended until the tympanic membrane repairs itself.
Acoustic Trauma to the Ear
Acoustic trauma occurs when the inner ear is exposed to a high decibel sound. It can be a sudden high decibel sound that occurs over a short period of sounds, such as a loud crash or another banging sound. The longer the exposure to high decibel noise, the more likely it is to suffer from this kind of trauma. The eardrum may or may not be affected by an acoustic trauma situation.
Those people at highest risk for acoustic trauma include those that work in industrial areas where high decibel sound is present without the protective use of earplugs. People who are exposed to loud music or who spend time in gun ranges can experience acoustic trauma. Any exposure over 85 decibels for any length of time can contribute to a “threshold shift” in the inner ear, resulting in permanent hearing loss. If the tympanic membrane is also affected, the chances of a high decibel acoustic trauma leading to permanent hearing loss are greater.
The primary symptom of acoustic trauma is the loss of hearing, particularly at the frequency in which the damaging sound occurred in the first place. High-frequency hearing loss tends to pre-date low decibel hearing loss. When being tested for acoustic trauma, the doctor will assess your hearing at all different frequencies to see where the largest deficits occur. Tinnitus, which can be a buzzing, ringing or tinny type of sound may be present in place of normal hearing and can interfere with hearing at all frequencies.
The diagnosis of acoustic trauma is made by having a history of exposure to a loud sound or sounds. Then, audiometry is performed to find out where the acoustic deficits are in the range of frequencies possible. You may be able to hear fairly well when the sound is from one frequency but will not be able to hear other frequencies very well.
The best treatment for acoustic trauma is to have a hearing aid. There are many kinds of hearing aids available on the market which can improve hearing at all frequencies. Some patients opt for a surgical procedure in which a cochlear implant is inserted to help to hear caused by acoustic trauma. Ear plugs are recommended to prevent further hearing loss from occurring. Oral corticosteroid medication is sometimes used to improve hearing.
Most people do not recover well from acoustic ear trauma. The goal in those who are suffering from this type of trauma is to wear ear protection so that further damage does not occur. If the hearing loss becomes profound and the individual is declared “deaf” even with a hearing aid, sign language may have to be the only option for hearing and for being heard.
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