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Evaluation and management of middle ear trauma

Adele Karen Evans, MD, FAAP
Steven D Handler, MD, MBE
Section Editors
Richard G Bachur, MD
Maria E Moreira, MD
Deputy Editor
James F Wiley, II, MD, MPH


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: Clinical manifestations, diagnosis, and management" 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 [4].

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) [3,4,6-10].

Barotrauma with middle ear injury can occur during air travel, scuba diving, or exposure to a blast. (See "Ear barotrauma", section on 'Etiology'.)

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Literature review current through: Oct 2017. | This topic last updated: Aug 11, 2016.
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