耳外伤

耳廓外伤 耳廓挫伤：擦伤、血肿 处理原则： 擦伤 自愈 血肿 穿刺、加压包扎 手术清除积血 预防感染

耳廓外伤 耳廓撕裂伤：皮肤裂伤、软骨裂伤、 部分断离、完全断离 处理原则 清创缝合、准确对位、小针细线 皮瓣修复 断耳再植 预防感染

鼓膜外伤 病因 器械伤：硬物挖耳、 压力伤：掌击、爆震、跳水 烧伤：钢花、矿渣、腐蚀性液体 医源性损伤：取耵聍、异物 颅脑外伤 Patients with multiple systems trauma must proceed according to the ATLS protocol and often the otolaryngologist is notified after its been completed, but should not be overlooked in the fundamental approach to evaluation of a trauma patient. Of course a thorough H&P consisting of a thorough and well document Head and Neck exam is necessary. Foreign bodies are more accountable for injuries to the TM, Ossicles and Facial Nerve without temporal bone fractures.

鼓膜外伤 临床表现 检查 耳痛、耳鸣、耳闷感 出血 听力减退 眩晕 裂隙状/不规则穿孔 血迹、水样液 传导性/混合型聋 A complete physical examination will often reveal the type of injury even before radiographic evidence can confirm it. The classic PE findings of a Basilar skull fracture are Periorbital Ecchymosis (raccoon’s eyes), Mastoid ecchymosis (battle’s sign) and Hemotympanum. The external canal and TM is more commonly lacerated in Longitudinal fractures which allows for blood or CSF otorrhea Whereas the intact external canal assoc w/ transverse fractures may lead to a buildup of blood or CSF behind and intact TM

鼓膜外伤 治疗原则 保持外耳道干燥,禁滴耳 预防感冒，勿用力擤鼻 重伤者暂不清理，无菌棉球堵塞外耳道口 The tuning fork exam is a quick way to evaluate hearing in the emergency room setting. Likewise, Pneumatic otoscopy may initiate the nystagmus and vertiginous symptoms of a PLF, or even reveal a subtle fracture of the malleus.

颞骨骨折 纵行骨折 横行骨折 混合性骨折 岩尖骨折 High resolution CT scanning with bone windows are the standard in diagnosis for identifying and classifying lesions of the middle and inner ear. MRI is becoming more prominent in identification of subclinical CNS injuries, especially in patients that are considered for surgical intervention for facial nerve lesions by documenting preexisting CNS injury and determining the risk of potential morbidity in patients undergoing middle cranial fossa approach for facial nerve injury. MRI evaluation of the facial nerve has been of interest in Bell’s Palsy, and is gaining some interest in evaluation of nerve edema/compression in trauma evaluation. In a study by Haberkamp, gadolinium enhanced MRI was found to be helpful in accurately predicting the site of facial nerve injury as a result of trauma with focal enhancement of the lesion. In the case of penetrating injuries, if there is any concern of risk to the internal Carotid artery, angiography or MRA is necessary.

纵行骨折 70% — 80% 骨折线与岩部长轴平行 中耳受损，极少伤及内耳 传导性/混合型聋 15-20% 面瘫 外耳道裂伤 The most common temp bone fracture (80%) Results from forces applied in the lateral projection, then traveling along the path of least resistance with the petrosquamous suture line anterior to the otic capsule. Sometimes involving the TMJ. 15-20% have Facial nerve injuries, and are sometimes often delayed in onset attributed to edema rather than laceration. Vestibular and sensorineural deficits are relatively uncommon, and are attributed to concussive effects rather than direct trauma on the labyrinth or cochlea. The External Canal is often disrupted.

横行骨折 20% 骨折线与岩部长轴垂直 常累及内耳 感音性聋、眩晕 50% 面瘫 外耳道完整 A much less frequent is the transverse fracture which is generated by forces in the Antero-Posterior axis. These fractures require much more energy and are more commonly associated with more serious or even fatal head injuries. The facial nerve is involved in 50% of the cases The External canal is usually intact

脑脊液漏 脑脊液耳漏 脑脊液鼻漏 糖定量 >1.7mmol/L

颞骨骨折 治疗原则 神经外科处理为主，注意生命体征 严防颅内或耳部感染 耳道出血禁止填塞(须根据实际情况，可适当以碘仿纱条填塞) 及早手术处理面瘫 后期手术处理鼓膜、听骨等