MIDDLE EAR TRAUMATISMS

CLASSIFICATION
1.DIRECTLY TRAUMATISMS
THE TYMPANIC MEMBRANE TRAUMATISMS BY
FOREIGNS BODY
TYMPANIC MEMBRENE BURNS
PRESIONAL TRAUMATISMS- BLAST, BARO TRAUMAS,
BANG SUPERSONIC
ACOUSTIC ACUTE TRAUMA
ELECTRICALY TRAUMATISMS
2. INDIRECTLY TRAUMATISMS
ASSOCIATED TRAUMA
LABIRINTHI FRACTURE
EXTRALABIRINTH FRACTURE
3. OSSICULAR BONES INJURIES
LABYRINTHINE CONCUSSION























































TYMPANIC TRAUMATISMS PRODUCED BY FOREIGNE
BODY

Symptomatology: pain, subepithelial hemorrage
TM perforation with osicular chain dislocation,
vestibular(vertiginous) phenomena
ENT Examination: perforation in the centre of the MT
Treatment: suction, dry endaural dressing in the
external auditory canal
TYMPANIC MEMBRANE BURNS
Symptomatology:
Intensive pain
EAC with (pete marmorate) marble trourought spots
TM hypermia, and hiperemic,turgid
large TM perforation situated in anthero-inferior part
of the MT
Treatment:
Endaural dressing
Antibiotic treatment
MYRINGOPLASTY after 6 month after one
suppuration
BARO TRAUMATISMS

It is produced by a pressure increasing of surrounding
environment ,after one applying one box on the ear.
Valsalva maneuver is difficult to performed
Symptomatology:
The tympanical congestionin the eptimpanic region
Difuze congestionwith a retraction of the MT
Hemothympan
Linear breack of the MT
Affects the Ossicular chain functionality
BARO TRAUMAS
Hearing loss by unilateral compression
Hearing loss by bilateral decompression- is progressively
installed ,horinzontal curve
BARO TRAUMATISMS FROM AVIATION
Classification:
Acute: ear pain, tinnitus, vertigo
Subacute: transient and vague ear pain
Chronic : low frequency transmission hearing loss- after it
is turns into mixed hearing loss, and large perforation
ENT Examination: thickened and retracted Tympanic
membrane, hammer leveling, unilateral pain, vertigo,
tinnitus, and large perforation
Treatment: cleaning the EAC, after that Myringoplasty

BLAST
Movement of air mass by explosion and deflagration
It produced degenerative lesions to the labyrinth by internal ear
hemorrage and concussion
SUPERSONIC BANG
It is produced by 130-145 dB sonic energy, that has a short time
action
In this situation are produced hydrodynamical changes due to a
fragile cochlea
Symptomatology: plugged ear , hearing loss with associate
vertigo, degenerative labyrinth Lesions(injuries) , neural sensory
hearing loss to high frequency

Treatment:
Vasodilatators drugs
ACOUSTIC ACUTE TRAUMA
- Appears trough exposer to loud noise over a 2 hours-7
days period of time
- Perception hearing loss by high frequency with a noch
by 400 Hz.
- Nervous exhaustion Phenomenon
- Treatment: vasodylatatory and vitamins drugs

ELECTRICAL TRAUMATISMS
It is produced by electrocution
Is produced:
- Directly primary lesions of TM
- Late secondary lesions

Perception or mixed hearing loss
Tympanic membrane perforations
Associated phenomena: bone necrosis, psichiatric
disorders, cerebral atrophy, affecting language, facial
paralysis, ocular complications
INDIRECTLY MIDDLE EAR TRAUMATISMS
ASSOCIATED TRAUMAS
- Mastoidean traumas
- Temporo-parietaly
- occipital
- occipito-parietal
Longitudinal fractures- tympanic membrane and tympanic
cavity with intact maintaining of facial nerve
Transverse fracture-way, vestibule, cochlea ,inferior wall of
Tympanic cavity, N. facial without affecting the
tympanic membrane
Oblique fractures


LABYRINTH AND EXTRALABYRINTH FRACTURES
Fracture Labyrinth: Bony labyrinth fracture. The bony
labyrinth, fracture of temporaly bone , and labyrinthine
concussion
Fracture Extralabyrinth : fracture of tymoanic cavity , tip
rock, mastoidean cells and EAC
Symptoms:
- Perforation of tympanic Membrane
- othoragy
- licvoree
- hearing loss to Deafness
- Balance disorder
Paralysis N. V, VI, VII
Treatment: conservative or surgical- mixed surgical teams

POST TRAUMATICALY LESIONS OF THE
TYMPANO-OSSICULAR SYSTEM
Symptomatology:
Transmission hearing loss, that will transforme in mixed and
neural or perception
Tinnitus
Balance disorders
Localisation: Incudo-stapedian joint , long incus apophyses,
stedo- vestibular joint
Clinical Diagnosis:
Tympanometrie with stapedian reflex
Tonal Audiometry
Opening the tympanic cavity to make the diagnostic
Treatament:
Surgical-ossicular bones
LABYRINTH CONCUSSION
It is a clinical manifestatio in the absence of a fracture
Definition: irreversible damage to neurosensorial elements-
oval window and the first round of turns of the cochlea
Symptomatology:
Hearing loss
Tinnitus
Nevralgic ear pain
Perception Hearing loss degenerative type by high
frequency and after that by low frequency
Treatment: it is necessary to make stimulator implants
transistors