Damage to the external auditory canal: causes, symptoms, diagnosis, treatment

Damage to the external auditory canal occurs much less frequently than damage to the auricle. They are caused by blows with a blunt or sharp object to the area of the external opening of the external auditory canal, bullet and shrapnel wounds. Damage may be limited to the cutaneous-membranous part of the external auditory canal or affect its bone part with or without a fracture of its bone walls. As a rule, fractures of the bone walls are accompanied by more extensive lesions of the surrounding anatomical structures bordering one or another wall. Often, when falling on the chin or receiving a strong blow to it, a fracture of the anterior wall of the bone section of the external auditory canal occurs with wedging of the head of the lower jaw into the retroauricular region.

Symptoms of damage to the external auditory canal

Injuries to the external auditory canal are accompanied by bleeding from it and the formation of a blood clot in the lumen, causing almost complete conductive hearing loss. When the clot is removed, hearing is fully restored only if there is no rupture of the eardrum.

The victims complain of ear pain, sudden congestion. During otoscopy, blood clots are detected in the external auditory canal, and after their removal, injured areas of the skin. Palpation with a button probe in some cases allows one to exclude or establish damage to the bone wall or the presence of a wounding projectile, but the actual condition of the injured area can only be determined as a result of an X-ray examination.

Damage to the external auditory canal is often combined with damage to the auricle and is considered a traumatic disease of the outer ear. However, special attention is paid to the functional state of the organ of hearing and the vestibular apparatus to exclude damage to the middle and inner ear. For this purpose, an X-ray examination of these parts of the temporal bone is used. In case of blunt trauma to the outer ear, attention is paid to the state of the central nervous system, since such injuries often show signs of concussion and even contusion of the brain. All patients with this type of trauma to the outer ear are subject to examination by a neurologist.

Diagnosis of traumatic injuries of the outer ear is based on anamnesis, otoscopic picture, probing of the wound canal and radiography. In the presence of general neurological symptoms (headache, nausea, vomiting, disorientation, prostration, difficulty communicating, etc.), hospitalization in the neurological department with simultaneous observation of an ENT specialist is indicated after specialized ENT care.

Treatment of damage to the external auditory canal

General rules for treating wounds and open injuries to any part of the body include primary treatment of the wound surface and stopping bleeding (if any), as well as the administration of anti-tetanus serum according to a special regimen.

In case of shallow wounds of the external auditory canal, turundas soaked in syntomycin emulsion or solutions of broad-spectrum antibiotics mixed with hydrocortisone are inserted into it after defecation. The same treatment is followed for deeper damage to the skin and membranous-cartilaginous tissues of the external auditory canal. Dressings are made once a day with mandatory defecation of the external auditory canal and removal of remnants of the applied medications (ointments, emulsions, liniments). In case of ruptures of the skin-membranous formations of the external auditory canal, their anatomical integrity is restored endoscopically using microinstruments, followed by fixing tamponade of the external auditory canal with turundas with synthomycin liniment for 48 hours. The turundas are removed carefully, step by step, after soaking them in hydrogen peroxide through a thin needle, so as not to displace the fragments of the external auditory canal laid out in the required order.

In case of fractures of the bone walls of the external auditory canal, the above-described measures are carried out with simultaneous immobilization of the lower jaw for 1-2 weeks, while only liquid food is prescribed, excluding the chewing process. Subsequently, during the consolidation of soft and bone tissues, a bougienage tube made of indifferent plastic, such as polyvinyl chloride, is inserted into the external auditory canal to prevent stricture and atresia. Since the scarring process continues after epidermization of the damaged skin for several weeks, this protector is kept in the ear canal for approximately the same time with periodic removal for its disinfection and toilet of the external auditory canal.

The prognosis is generally favorable, however, if specialized care is not provided in a timely manner or if infected injuries are treated incorrectly, in a significant number of cases disfigurement of the auricle or stenosis or atresia of the external auditory canal occurs, which subsequently require appropriate plastic surgery.

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