OtoRhinoLaryngology Portal

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Localized Liquified Pinna Haematoma

  

Pinna Haematoma

Haematoma need to be evacuated as the cartilage will be deprived of its nutrients and oxygen supply as its perichondrium becomes separated. 

Diagnostic aspiration revealed dark-red blood.  

Temporary pressure bandage and an antibiotic course usually prescribed.

Traumatic Pinna Laceration

 

 Complete horizontal cut of right pinna sustained after metal rod hit.

Toilet and suturing with minor debridement was performed and antibiotic prescribed.

Ear Canal Trauma: Healed Laceration

Healed ear canal skin laceration complicating self ear cleaning using metal ear curette.

Ear Canal Trauma: Blood Clot

Ear canal trauma can results in abrasion or laceration.  In this case the trauma was caused by accidental poking by sharp end of metal curette.  It heals readily.

Iatrogenic Lacerations

Iatrogenic lacerations (X) and eardrum perforation (arrow) complicating removal of tic (T) by inexperienced hands! 

Traumatic Eardrum Perforation

The edges of an eardrum perforation due to injury are usually jagged or non-smooth.  Fresh blood, clots and subepithelial bruises are usually present depending on severity and duration.  Concomitant middle & inner ear injury need to be excluded.  Audiometry test is strongly recommended; beware of potential medico-legal implications.

Fresh traumatic eardrum perforation involving posterior pars tensa with its torn segment still attached and flipped anteriorly.

A recent eardrum perforation complicating a hard slap onto the right ear.

Linear eardrum perforation located adjacent to the cone of light area.

Careful history revealed these perforations were traumatic in nature.

 Accidental injury sustained while performing self-cleaning of the ear canal using cotton bud which resulted in ear canal laceration and eardrum perforation (arrow).  The left figure is the endoscopic view 2 weeks after the injury showing dry adherent clot (black coloured) which will eventually cleared naturally by intrinsic epithelial migration of the ear canal. 

 

 An estimated forty percent anterior central perforation 72 hours after the traumatic insult. Note the folded torn membrane anteriorly and blood clot in the middle ear.

 

A large traumatic central perforation.  (green arrow -incudospedial joint, white arrow - lateral process of malleus)

  

Recent barotraumatic perforation resulting in a large central perforation. 

Bare distal handle of malleus and middle ear mucosa were clearly seen.

 Traumatic double perforations of left eardrum.

 

Watch video of barotraumatic tympanic membrane perforation @ YouTube

Haemotympanum in Skull Base Fracture

Haemotympanum appears as bluish/reddish fluid behind the eardrum.

  It is usually related to trauma e.g.,skull base fractures

and can be mixed with cerebrospinal fluid (CSF).

Frank haemotympanum in a patient with base of skull fracture.

Haemotympanum of few days duration complicating skull base fractures after head injury during fits.

 

Watch video of haemotympanum @ YouTube

 

Watch video of Battle sign in skull base fracture @ YouTube

Temporal Bone Fractures: Frank Blood Otorrhoea

Conservative management of fractures showing drying up of fresh blood in the ear canal over few days and resolving haemotympanum.  There was minimal conductive hearing loss and the facial nerve was intact.  CT-scan confirms the fracture sites and its extent.

Axial view CT-scan showing the fractures (arrows).  (X - blood in sphenoid sinus or haemosinus)

Cerebrospinal Fluid (CSF) Otorhinorrhoea

Cerebrospinal Fluid Otorrhoea

Blood-mixed CSF otorrhoea of traumatic origin.

Mastoid air cells transected with haemosinus complicating low craniotomy performed for surgical removal of ipsilateral temporal lobe tumour.

Eardrum & External Ear Canal Injuries

The endoscopic view of ear canal shows torn right eardrum and lacerated ear canal skin (arrows) in longitudinal fractures of temporal bone.  (TM- tympanic membrane, M - handle of malleus, stars - blood clots).

 Endoscopic appearance of the ear canal of the same patient 2 weeks after the traumatic injury.  Diamond - fractured bony edges with healed overlying epithelium, TM - tympanic membrane covered by a thin sheet of dried blood.  The earlier "torn" eardrum was unintentionally reported as torn tympanic membrane by high resolution CT-scan of the temporal bone.

Healed fractures with deformed osseous external auditory meatus (arrow).  The eardrum is retracted with middle ear effusion formed due to Eustachian tube dysfunction secondary to fractures involvement during impact.

 Bony defect (red arrow) in a patient who had previous motor-vehicle accident.  His main complaints were hearing loss and persistent tinnitus.  (white arrow- chorda tympani nerve}.. 

The "Blue" Eardrum

Confluent bluish-red fluid behind the eardrum in a patient with postnasal tumour.

Barotrauma

This is an acute condition whereby otological injury occurs as a result of significant differential pressure between the middle ear and the atmospheric air pressure outside the eardrum.  Its symptoms include ear discomfort, earache, fullness sensation, reduce in hearing, and dizziness. Depending on its severity, eardrum erythema, retraction, subepithelial bleed, haemotympanum,

and even perforation can happen.

Figure shows patchy subepithelial bleeding of the eardrum

with visible blood streaks alond the border of malleus handle.

Barotrauma resulting in haemorrhage into middle ear

and suffusion of peripheral eardrum vasculatures.

Blood-tinged middle ear effusion.

Middle ear haemorrhage and eardrum retraction resulted from barotrauma.  The patient had taken air flight despite having flu and thereafter experienced persistent left earache upon descent.

Barotrauma resulted from scuba diving 2 days earlier.  Note middle ear effusion with tinge of purplish discolouration due to middle ear bleeds. 

 

The opposite eardrum of the same patient above showing blood-stained middle ear effusion with retracted eardrum. 

Perforation resulted from barotrauma of scuba diving 1 month after injury.  The middle ear mucosa is healthy and hypotympanic air cell are seen clearly.

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