Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVI: Wounds and Injuries of the Ear

The Middle Ear

United States Department of Defense

Injury of the tympanic membrane, which is common, is often associated with other much more serious injuries of the middle ear. The damage may be caused by direct penetration of a missile, by a fracture of the base of the skull involving the tympanic ring, or by sudden compression of the air in the external auditory meatus as the result of blast. A blast injury may cause a small hemorrhage in the substance of the membrane, rupture of the outer fibers, or a linear tear; or it may result in complete disintegration. The great risk is secondary infection, with possible deafness likely to be the end result.

Injury of the middle ear often does not present clear-cut symptoms. When it is suspected, the ear should be examined under aseptic precautions, with good illumination.

If rupture has occurred, instrumentation, drops, and syringing are all contraindicated. Wax is left in situ unless pain, deafness, or both require its removal. This is seldom necessary in a forward hospital. Eighty percent of these perforations will close spontaneously.

Treatment in the forward area consists of simple protection of the ear with a sterile dressing or a loose packing of sterile cotton. If the pinna is also damaged, the meatus should be packed with sterile cotton while the outer ear is being cleansed.

Until the ruptured tympanic membrane has healed, every precaution is taken to avoid nasopharyngeal infection. The patient is warned not to blow his nose. If suppuration occurs, it must be vigorously treated by ear drops and other standard measures to prevent chronicity. Delayed cholesteatoma formation is common in blast injuries.

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Operational Medicine 2001

Health Care in Military Settings

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