Middle ear trauma arises from blunt or penetrating head injury, direct ear trauma, or barotrauma caused by events such as blast injury, air travel, or scuba diving. Pediatric and adult injuries require the same steps in management. Patients with isolated small tympanic membrane perforations may be managed with antibiotic ear drops for contaminated wounds, water precautions (keeping water out of the middle ear), and reevaluation to ensure that the perforation has healed. Patients with significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, or facial nerve injury warrant prompt evaluation by an otolaryngologist (ENT surgeon) or other specialist as indicated (eg, neurosurgeon for head injury).
The management of blunt or penetrating middle ear trauma will be reviewed here. The evaluation and management of ear barotrauma and temporal bone fractures are discussed separately. (See "Ear barotrauma" and "Skull fractures in children" and "Skull fractures in adults".)
Middle ear injury or injury to adjacent inner ear structures or both occurs in up to one-third of patients with severe head trauma and over one-half of patients with temporal bone basilar skull fractures [1-3]. These injuries include hemotympanum (picture 1), hearing loss, cerebrospinal fluid (CSF) fistula, otic capsule injury, and traumatic perilymphatic fistula [1-5].
Otic capsule injury is four to five times more likely if temporal bone fracture occurs with facial nerve paralysis, CSF otorrhea, or both .
Middle ear injury may also occur after direct blunt trauma to the external auditory canal (eg, hand blow to ear ["boxed ears"], fall onto the ear while water or snow skiing, motor vehicle collision, sports injury [eg, wrestling]) or penetrating trauma (eg, Q-tip, matchstick injury, gunshot wound, welding or soldering spark) [3,4,6-9].