Ear Injuries and Trauma

What are ear injuries and ear trauma?

Injuries can happen to any part of your ear, including your inner ear, middle ear and outer ear (the part of the ear you see and the ear canal).

Trauma (like a blow to the head) can cause damage in your 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 (barotrauma) or foreign objects in the ear.

Types of ear injuries

Injuries can happen to the outer ear or any part of your middle and inner ear. This can include damage to your ear canal, eardrum, cartilage and the skin around your ear.

Outer ear injuries

The most common types of outer ear injuries include:

• Avulsion (pulling or tearing away): 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.
• Cauliflower ear: This is an outer ear injury that happens after getting hit, often from contact sports like 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.
• 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.

Middle and inner ear injuries

Middle and inner ear trauma can cause severe damage and can affect hearing. The most common injuries to the inside of your 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.
• Ruptured eardrum: This is when your eardrum tears due to trauma or loud noises. Some ruptured eardrums heal on their own. But some people need surgery to fix it.

What are the symptoms of ear injuries?

If you have a damaged ear, you might develop:

• Balance issues.
• Dizziness.
• Earaches.
• Ear bleeding.
• Headache.
• Hearing loss.
• Pus or bleeding from the ear.
• Tinnitus (buzzing or ringing in the ear).

These injuries can cause ear bleeding, ear pain, balance issues and hearing loss. A severe ear injury can be life-threatening.

What causes ear injuries?

There are several causes of ear injury and trauma, including:

• Accidents: Trauma from falls, car accidents or contact sports can cause serious ear injuries.
• Changes in pressure: Scuba diving and flying on an airplane can lead to a ruptured eardrum.
• Foreign objects: Sticking pens, cotton swabs and similar objects in your ear can cause trauma to your ear canal. These injuries can break small bones in your ear or split or tear (rupture) your eardrum.
• Loud noises: Eardrums can also tear due to loud noises, like gunshots, explosions and loud music concerts. Long-term exposure to loud noise can cause permanent hearing loss.

What are the complications of ear injuries and trauma?

In severe cases, ear and head trauma can lead to serious complications, 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 issues with balance and vertigo.
• 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.

How are ear injuries diagnosed?

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, like an MRI (magnetic resonance imaging), so your provider can see pictures of your inner ear. Your provider may also order a hearing test to check for hearing loss.

How do you treat an ear injury?

Treatment varies depending on the location, severity and cause of the injury. Your provider may prescribe antibiotics to prevent or treat infection. Other treatments may include:

• Draining the blood: If blood pools in your outer ear, your provider makes a small incision (cut) to drain it. They’ll apply a special bandage that stays in place for several days. This procedure treats bleeding into the skin and can prevent cauliflower ear from developing.
• Ossiculoplasty: This type of surgery repairs damage to the tiny bones in your ear (ossicles). These bones help you hear.
• Reconstructive surgery: Plastic (cosmetic) surgeons can repair damage to your outer 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.

Are ear injuries preventable?

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:

• Avoid loud noises or wear ear protection (for example, if you’re on a construction site).
• Don’t put anything in your ears, even to clean them.
• Get special earplugs, use chewing gum or yawn to reduce pressure when flying on an airplane.
• Lower the volume on earbuds and headphones.
• Use a helmet when riding a bike, skateboard or motorcycle.
• Wear protective headgear during contact sports like boxing, rugby and wrestling.

What’s 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. But other injuries, like deep cuts or fractured bones in your inner ear, require surgery.

When should I see my healthcare provider?

See your provider right away if you or your child has a bleeding ear after a head injury. This is a serious symptom that could be a sign of bleeding around the brain.

You should also watch for:

• Clear fluid coming from your ear that doesn’t stop or causes your pillow to be wet in the morning.
• Confusion.
• Severe ear pain or headaches.
• Sudden hearing loss, dizziness or balance issues.
• Vomiting.

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.