Damage to the eardrum

Damage to the eardrum are divided into domestic, industrial, and wartime. Pathogenetically, these lesions are divided into mechanical and burn.

[1], [2], [3], [4]

Causes damage to the eardrum

Domestic mechanical damage occurs when a subject is directly exposed to the eardrum by an object inserted into the external auditory canal to cleanse it from earwax or accidentally got into it, when an open palm is struck on the auricle (a sharp increase in pressure in the external auditory canal), or with a sneeze with squeezed nostrils (a sharp increase in pressure in the tympanic cavity, eardrum), or when kissing in the ear (negative pressure in the external auditory canal), leading to rupture eardrum. Mechanical damage to the eardrum can occur when falling on the ear, with its deeper injuries, accompanied by a violation of the integrity of the tympanic cavity and the pyramid of the temporal bone, in cases where the fracture line passes through the drum ring. Domestic damage can be attributed to thermal and chemical burns resulting from an accident. These burns are usually accompanied by damage to the auricle.

Production lesions of the eardrum are divided into barometric, due to a sharp air pressure drop (in caissons, pressure chambers, in diving suits, with technological explosions, etc.), thermal (in the metallurgical industry, in forging, pottery, etc.) and chemical in contact with caustic liquids in the ear canal and on the auricle.

Damage to the eardrum of a military nature are divided into firearms (bullet, fragmentation) and barometric or detonation (according to V.I. Voyachek), due to the mine-explosive effect.

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Pathogenesis and pathological anatomy

With increasing barometric pressure in the external auditory canal or the tympanic cavity, a tympanic membrane is stretched, at which its structures are deformed, and depending on the pressure force this deformation can occur at the cellular level, as well as at the microfiber and microvascular levels. With such injuries, only individual elements and layers of the eardrum can be affected without a total violation of the integrity of all its layers. With the weakest effects, an injection of vessels in the relaxed part and along the hammer handle can be observed, with a more severe injury associated with rupture of the eardrum vessels, hemorrhages occur in it, and with a significant barometric effect - a complete rupture of the eardrum, which due to the elasticity of the average the layer stretching the wound edges is visualized as a hole with jagged (ragged) edges covered with a small amount of blood. A similar, but pathoanatomically more pronounced pattern is observed in the production and detonation-explosive injuries of the eardrum. Gunshot wounds are characterized by significant damage not only to the eardrum, but also to surrounding tissues.

All types of mechanical injury of the eardrum with a violation of its integrity are infected, which creates the risk of a secondary infection with severe clinical consequences (acute suppurative otitis media and mastoiditis, labyrinthitis, sinus thrombosis, etc.).

Acid and caustic alkali burns of the eardrum, as a rule, lead to its complete destruction, and often to the destruction of the structures of the middle ear and penetration of the caustic substance through the vestibular and drum windows in the maze with terrible consequences for the auditory and vestibular functions.

[6]

Symptoms of eardrum damage

Injury of the eardrum is accompanied by the appearance of sharp pain, ear congestion, hearing loss and noise in the ear. During otoscopy, various variants of traumatic damage to the eardrum can be observed - from a light injection of blood vessels along the handle of the malleus to massive hemorrhages, slit fractures, scalloped perforations to subtotal defects of the eardrum. In the presence of perforation of the eardrum, patients sometimes report that when blowing their nose (Valsalva maneuver), air escapes from the damaged ear. This fact indicates the presence of perforation of the eardrum, however, this test is not recommended due to the possibility of carrying the infection into the middle ear from the nasal cavity through the auditory tube and a damaged eardrum. Further clinical course is determined by the degree of violation of the integrity of the eardrum and the possible addition of a secondary infection.

In the case of small slotted perforations, in the overwhelming majority of cases, their edges stick together and a spontaneous healing of the injured tympanic membrane occurs, after which either there are no traces of perforation on it, or scars of various sizes are formed, which eventually get saturated with calcium salts, which are defined as white, " embedded in the thickness of the eardrum. In such cases, the auditory function remains normal. With significant breaks with the divergence of the wound edges, massive scarring of the eardrum occurs with the formation of coarse calcinates (the so-called adhesive otitis) or persistent single perforation. In these cases, signs of conductive hearing loss of varying degrees are detected.

With extensive trauma of the eardrum, the auditory ossicles, their joints and internal muscles of the tympanic cavity may be involved in the traumatic process. The most frequent occurrence of this is the breaking of the hammer-forged or anvil-temporal articulation, as well as the fracture of the legs of the stirrup and subluxation or the fracture of its base. When the chain of the auditory ossicles is broken, a sudden almost complete conductive hearing loss occurs, and if the base of the stirrup is damaged, there is a sharp noise in the ear, the hearing loss becomes mixed, phenomena of vestibular dysfunction and outflow of perilymph may be observed.

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Treatment and prognosis of eardrum damage

With uncomplicated damage to the eardrum, therapeutic measures are minimized. Any active manipulations in the external auditory canal and on the eardrum, dropping and ear washing are prohibited. In the presence of blood clots in the external auditory canal, they are carefully removed with dry sterile cotton wool, the walls of the auditory canal are treated with moistened ethyl alcohol and cotton wool pressed and the dry sterile turunds are laid in it loosely. In case of complications in the form of purulent inflammation of the middle ear, treatment is carried out corresponding to acute purulent otitis media. If you suspect damage to the structures of the tympanic cavity, appropriate treatment is carried out until the acute events subside and the damage to the eardrum is repaired. In the future, the victim is examined for hearing and vestibular function and determining the nature of further treatment.

The prognosis depends on the volume and depth of damage to the eardrum and structures of the middle ear, and determine it in relation to secondary infection and auditory and vestibular functions. In most cases, in the absence of these complications, the prognosis is favorable. The accession of a secondary infection or the presence of dissociation of the chain of the auditory ossicles is predictable and depends on further special treatment.