Ear Injuries and Trauma
What are ear injuries and ear trauma?
Injuries can happen to any part of the ear, including the inner ear, middle ear and external ear, which is the part of the ear you see and the ear canal. Trauma (such as a blow to the head) can cause damage in the middle ear (the space behind your eardrum) and inner ear (the series of canals and tissues on the inside of your head). An ear injury can result from loud noises, changes in air pressure or foreign objects in the ear.
Many different types of accidents can damage your ear canal, eardrum, cartilage and skin around your ear. The ear canal is a passageway of bone, skin and cartilage that leads from the exterior ear to the middle ear, where your eardrum sits. The eardrum is a thin membrane that protects your ear from bacteria and conducts sound.
These injuries can cause ear bleeding, ear pain, balance problems and hearing loss. A severe ear injury can be life-threatening. If you had a head injury and you have blood coming from your ear, seek medical help right away.
What are the types of ear injuries?
Injuries can happen to the outer ear or any part of the middle and inner ear. Severe trauma can cause injuries to all parts of the ear. The most common types of injuries to the outer ear include:
- Avulsion: During an accident or trauma, part of the ear can tear off. The ear can pull away from the head, either partially or completely. Some avulsion injuries require cosmetic surgery to repair the ear.
- Cuts and scratches: These injuries are usually minor. They can happen if you insert your fingernail too far or too forcefully into your ear. They can also result from an accident. Deeper cuts may need stitches or they could get infected.
- Subperichondrial hematoma (cauliflower ear): This injury results from trauma to the exterior ear, often from contact sports such as rugby and wrestling. Blood pools under the skin in the outer ear and cuts off the blood supply to the cartilage, which causes the cartilage to die. The pooling blood is a type of bruise called a hematoma. If the blood does not get drained, over time, the ear cartilage will look rippled, lumpy and swollen (kind of like a cauliflower).
Injuries to the middle ear and inner ear can cause severe damage and can affect hearing. The most common injuries to the inside of the ear include:
- Fractures: In a serious accident, bones in the middle ear can fracture (break) or become dislocated. This injury usually happens along with fractures in the jaw and face. Providers call these bones ossicles or “hearing bones.” This injury may need surgical repair.
- Injuries from foreign objects: More common in children, these injuries happen when someone inserts a pencil, toy, cotton swab or another object too far into the ear. These injuries can break small bones in the ear or split or tear (rupture) the eardrum.
- Ruptured eardrum (perforated eardrum): Trauma, loud noises, severe ear infections and foreign objects can cause a ruptured eardrum. A sudden change in air pressure (barotrauma) when flying on an airplane or pressure changes from scuba diving can cause an eardrum to tear. If clear fluid leaks from your ear and you are dizzy, you should seek medical care immediately.
Symptoms and Causes
What are the symptoms of ear injuries?
The symptoms of ear trauma vary depending on the cause. They include:
- Ear pain (earache), which can be severe.
- Dizziness and balance problems.
- Hearing loss.
- Pus or bleeding from the ear.
- Tinnitus (buzzing or ringing in the ear).
What causes ear injuries?
There are several causes of ear injury and trauma, including:
- Accidents and injuries: Trauma from a fall, car accident or contact sports can cause serious ear injuries.
- Changes in pressure: Scuba diving and flying on an airplane can lead to a perforated (ruptured) eardrum.
- Foreign objects: Inserting a pen or another object into your ear canal can damage the bones, cartilage and tissue.
- Loud noises: Eardrums can also tear due to loud noises, such as gunshots, explosions and loud music concerts. Long-term exposure to loud noise can cause permanent hearing loss.
Diagnosis and Tests
How do healthcare providers diagnose ear injuries?
Your provider will ask about your symptoms and do a physical exam. They may use an otoscope (a special instrument with a light) or a microscope to look inside your ear. An otoscope allows your provider to check for foreign objects, infections or damage to your eardrum.
Depending on the type of injury, you may need an imaging study, such as an MRI, so your provider can see pictures of your inner ear. Your provider may also order a hearing test to check for hearing loss.
Management and Treatment
How do providers treat ear injuries?
Treatment varies depending on the severity of the injury, what caused it and the area of your ear that’s damaged. Your provider may prescribe antibiotics to prevent or treat infection. Other treatments may include:
- Draining the blood: If blood pools in your exterior ear, your provider makes a small incision (cut) to drain the blood. They will apply a special bandage that stays in place for several days. This procedure treats a hematoma and can prevent cauliflower ear from developing.
- Ossiculoplasty: This type of surgery repairs damage to the tiny bones in the ear (ossicles). These bones help you hear.
- Reconstructive surgery: Plastic (cosmetic) surgeons can repair damage to the exterior ear by reshaping the tissue. Using several reconstructive surgery techniques, they create a more natural ear shape. Plastic surgeons can also replace lost tissue using a skin graft.
- Stitches: Deep cuts may require stitches or surgical glue to close the wound. Providers use stitches to reattach torn cartilage and repair damage.
- Tympanoplasty: Many ruptured eardrums heal without treatment. In more serious cases, torn eardrums may need a type of surgery called tympanoplasty to patch the tear.
Can I prevent ear injuries?
You may not be able to prevent all types of ear injuries. To lower your risk of ear trauma and hearing loss, you should care for your ears properly, including:
- Avoiding loud noises or wearing ear protection (for example, if you’re on a construction site).
- Getting special earplugs, chewing gum or yawning to reduce pressure when flying on an airplane.
- Lowering the volume on earbuds and headphones.
- Using a helmet when riding a bike, skateboard or motorcycle.
- Wearing protective headgear during contact sports such as boxing, rugby and wrestling.
- Avoiding putting anything into the ears, even to clean them.
Outlook / Prognosis
What is the outlook for people with ear injuries?
The outlook varies depending on the type and severity of the injury. Many ruptured eardrums and minor ear injuries heal without treatment. In severe cases, ear and head trauma can lead to serious problems, including:
- Cerebrospinal fluid (CSF) leak, which can result from fractures in the head and the base of the skull. This can sometimes lead to meningitis, an infection of the lining of the brain.
- Long-term problems with balance and vertigo (dizziness).
- Paralysis of the face (muscles and nerves in the face can become damaged or paralyzed following a severe head injury).
- Permanent hearing loss.
- Recurring ear infections, which can happen when bacteria enter the inner ear through a torn eardrum.
When should I see my healthcare provider about ear trauma?
See your provider right away if you or your child had a head injury, as well as:
- Blood or clear fluid coming from your ear.
- Severe ear pain or headaches.
- Sudden hearing loss, dizziness or balance problems.
These are serious symptoms that may be signs of a life-threatening condition. Even if the head injury seemed minor, you should get medical help. Call your provider, dial 911 or go to the emergency room.
A note from Cleveland Clinic
Ear injuries can range from minor to life-threatening. If you or your child has severe ear pain, bleeding ears, dizziness or hearing loss, get help right away. These are signs of a serious medical condition, especially after a blow to the head, fall or other accident. To prevent an ear injury, never put anything in your ears. Wear protective headgear during contact sports. Avoid listening to music at high volumes, and wear ear protection if you’re exposed to loud noises.
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