Penetrating Middle Ear Trauma: A Report of 2 Cases

Abstract

Penetrating middle ear injury can result in hearing loss, vertigo, andfacial nerve injury. We describe the cases of 2 children with penetrating trauma to the right ear that resulted in ossicular chain disrupt ion; one injury was caused by cotton-tipped swabs and the other by a wooden matchstick. Symptoms in both children included hearing loss and otalgia ; in addition, one child experienced ataxia and the other vertigo. Physical examination in both cases revealed a pelf oration in the posterosuperior quadrant of the ty mpanic membrane and visible ossicles. Audiometry identified a moderate conductive hearing loss in one child and a mild sensorineural hearing loss in the other: Both children underwent middle ear exp loration and reduction ofa subluxed stapes. We discuss the diagnosis, causes, and management ofp enetrating middle ear trauma. To reduce the morbidity associated with these traumas, otologic surgeo ns should act promptly and be versatile in choosing methods ofrepairin g ossicular chain injuri es. Introdu ction Penetrating middl e ear and tympanic membrane inj uries in children can be se lf-i nflicted or ca used by caregivers or medical personn el. Damage can include tympanic membrane perforation, hemotympanum, inj ury to the ossicu lar chain or facia l ner ve, verti go, perilymphatic fistula, and conductive and/or sensorineural hearing loss."! Some injuries can be managed expec tantly or with elective surgical intervention while others require urgent surgical Fro m the Division of Pedi atric Otolaryngo logy, Department of Surge ry, A lfred I. duP ont Hosp ital for Childre n, Ne mo urs Children's Clinic, Wilmi ngton, De l., and the Department of Otolaryngology-H ead and Neck Surgery, Th omas Jefferson Un iversi ty Hospita l, Philadelphi a.

Traumatic tympanic membrane perforations: characteristics and factors affecting outcome

“…Penetration of the TM by objects may lead to ossicular chain disruptions in the middle ear. 4 It may also be complicated with suppurative middle ear disease if the penetrating object harbour some infective organisms as seen in some of our patients. Orji and Agu reported that healing of TTMP was delayed by middle-ear infection and confirmed that penetrating injuries sustained through the ear canal was an important risk factor in predicting non-healing of TTMP.…”

“…The TM injury can predispose to middle ear infection which has grave consequences including facial nerve paralysis, formation of cholesteatoma, perilymph fistula, intracranial infections and may require ear and intracranial exploration. 4 Significant morbidity or mortality can occur when traumatic ear injuries are associated with damage to contiguous facial structures and the brain. Effective management is expedient while prevention and reduction of complications must be given utmost attention to achieve a good outcome.…”

Outcomes for Conservative Management of Traumatic Conductive Hearing Loss

“…Management strategies for traumatic conductive hearing loss (CHL) are not as clear. Reports include immediate exploration and repair within days of traumatic injury (3,4), exploration and repair after 6 to 7 weeks for suspected traumatic ossicular lesions (5), or exploration and repair after 3 months (1,6,7). This variability may be due to the lack of data demonstrating the natural history of traumatic CHL.…”

Pediatric Cotton-Tip Applicator-Related Ear Injury Treated in United States Emergency Departments, 1990-2010

“…Previous studies have documented delayed treatment for severe CTA injuries, such as TMP, ossicular dislocation (joints between malleus-incus-stapes, or stapes footplate subluxation), hearing loss (conductive, sensorineural, or mixed), perilymphatic fistula, and facial nerve paralysis. 2,20 Smith et al reported a 7.4% rate of delayed surgical tympanic membrane repair after CTA injury. 2 In that study, TMP was seen in nearly 25% of cases, and foreign body sensation was the most common reason for ED visits.…”