Ent

1. INJURY OF THE TYMPANIC MEMBRANE
Injury
of
the
Tympanic
Membrane

2. • THE TYMPANIC MEMBRANE, BEING DEEPLY PLACED, IS WELL
PROTECTED FROM INJURY. DAMAGE DOES OCCUR, MAY BE
DIRECT OR INDIRECT.
• DIRECT TRAUMA IS CAUSED BY POKING IN THE EAR WITH
SHARP IMPLEMENTS, SUCH AS HAIR GRIPS, IT IS CAUSED BY
SYRINGING OR UNSKILLED ATTEMPTS TO REMOVE WAX OR
FOREIGN BODIES.
• INDIRECT TRAUMA IS USUALLY CAUSED BY PRESSURE FROM
A SLAP WITH AN OPEN HAND OR FROM BLAST INJURY; IT MAY
OCCUR FROM TEMPORAL BONE FRACTURE

3. • SYMPTOMS
• PAIN, ACUTE AT TIME OF RUPTURE, USUALLY TRANSIENT.
• DEAFNESS, NOT USUALLY SEVERE, CONDUCTIVE IN TYPE.
COCHLEAR DAMAGE MAY OCCUR FROM EXCESSIVE
MOVEMENT OF THE STAPES.
• TINNITUS, MAY BE PERSISTENT—THIS IS COCHLEAR DAMAGE.
• VERTIGO, RARELY.
• SIGNS
• BLEEDING FROM THE EAR.
• BLOOD CLOT IN THE MEATUS.
• A VISIBLE TEAR IN THE TYMPANIC MEMBRANE

4. • TREATMENT — LEAVE IT ALONE
• DO NOT CLEAN OUT THE EAR.
• DO NOT PUT IN DROPS.
• DO NOT SYRINGE.
• IF THE INJURY HAS BEEN CAUSED BY DIRECT TRAUMA, TREAT WITH
PROPHYLACTIC ANTIBIOTICS. IN OTHER CASES, GIVE ANTIBIOTICS
IF THERE IS EVIDENCE OF INFECTION SUPERVENING.
• IN VIRTUALLY EVERY CASE, THE TEAR IN THE TYMPANIC MEMBRANE
WILL CLOSE RAPIDLY. DO NOT REGARD THE EAR AS HEALED UNTIL
THE HEARING HAS RETURNED TO NORMAL.

5. MÉNIÈRE’S DISEASE
• MENIÈRE’S DISEASE IS A CONDITION OF UNKNOWN AETIOLOGY IN WHICH
THERE IS DISTENSION OF THE MEMBRANOUS LABYRINTH BY
ACCUMULATION OF ENDOLYMPH. IT CAN OCCUR AT ANY AGE, BUT ITS
ONSET IS MOST COMMON BETWEEN 40 AND 60 YEARS. IT USUALLY STARTS
IN ONE EAR ONLY, BUT IN ABOUT 25% OF CASES THE SECOND EAR
BECOMES AFFECTED.
• THE CLINICAL FEATURES ARE AS FOLLOWS.
• VERTIGO IS INTERMITTENT BUT MAY BE PROFOUND, AND USUALLY
CAUSES VOMITING. THE VERTIGO RARELY LASTS FOR MORE THAN A FEW
HOURS, AND IS OF A ROTATIONAL NATURE.
• A FEELING OF FULLNESS IN THE EAR MAY PRECEDE AN ATTACK BY HOURS
OR EVEN DAYS.

6. • DEAFNESS IS SENSORINEURAL AND IS MORE SEVERE BEFORE AND DURING AN ATTACK.
IT IS ASSOCIATED WITH DISTORTION AND LOUDNESS INTOLERANCE (RECRUITMENT).
DESPITE FLUCTUATIONS, THE DEAFNESS IS USUALLY STEADILY PROGRESSIVE AND MAY
BECOME SEVERE.
• TINNITUS IS CONSTANT BUT MORE SEVERE BEFORE AN ATTACK.
• TREATMENT
• General and medical measure
• BETWEEN ATTACKS, VARIOUS METHODS OF TREATMENT ARE USEFUL.
• FLUID AND SALT RESTRICTION.
• AVOIDANCE OF SMOKING AND EXCESSIVE ALCOHOL OR COFFEE.
• REGULAR THERAPY WITH BETAHISTINE HYDROCHLORIDE, 8–16 MG T.D.S.
• IF THE ATTACKS ARE FREQUENT, REGULAR MEDICATION WITH LABYRINTHINE
SEDATIVES, SUCH AS CINNARIZINE, 15–30 MG T.D.S., OR PROCHLORPERAZINE, 5–10MG
T.D.S., ARE OF VALUE. REGULAR LOW-DOSE DIURETIC THERAPY MAY ALSO BE OF
BENEFIT.

7. • SURGICAL TREATMENT
• LABYRINTHECTOMY IS EFFECTIVE IN RELIEVING VERTIGO, BUT SHOULD ONLY BE
PERFORMED IN THE UNILATERAL CASE AND WHEN THE HEARING IS ALREADY
SEVERELY IMPAIRED.
• DRAINAGE OF THE ENDOLYMPHATIC SAC BY THE TRANSMASTOID ROUTE.
• DIVISION OF THE VESTIBULAR NERVE EITHER BY THE MIDDLE FOSSA OR BY THE
RETROLABYRINTHINE ROUTE; THIS OPERATION PRESERVES THE HEARING BUT IS A
MORE HAZARDOUS PROCEDURE.
• INTRA-TYMPANIC GENTAMYCIN IS HELPFUL IN REDUCING VESTIBULAR ACTIVITY
BUT WITH A 10% RISK OF WORSENING THE HEARING LOSS.
• MENIÈRE’S DISEASE IS FORTUNATELY UNCOMMON, BUT MAY BE INCAPACITATING.
THE PATIENT REQUIRES CONSTANT REASSURANCE AND SYMPATHETIC SUPPORT