Perforación de la membrana timpánica asociada a trauma por explosivos / Tympanic membrane perforation associated to trauma by explosives

El oído y sus estructuras: membrana basilar, membrana timpánica y cadena oscicular son los órganos más frecuentemente afectados por una onda explosiva. El 38-92% de las perforaciones timpánicas por explosivos cierran espontáneamente, estas marcadas diferencias entre los reportes están influenciadas por múltiples factores como tamaño y localizaciónde la perforación, tipo de explosivo entre otros. El tratamiento es aun controversial: miringoplastia temprana, posicionamiento de un “parche” sobrela perforación y observación son recomendados. Objetivo: Determinar la severidad de las perforaciones timpánicas por explosivos y sus efectos en la audición. Diseño y métodos: Este es un estudio retrospectivo en soldados afectados por explosiones en combateen Colombia tratados en nuestra institución. Los datos recolectados incluyeron edad, género, localizacióny tamaño de la perforación, síntomas, resultados audiológicos (PTA), cierre espontáneo y tipo de explosivo.Resultados: Un total de 81 perforaciones timpánicas fueron encontradas. Las minas terrestres fueron los tipos de arma más utilizadas (57%). La mayoría de las membranas (83%) presentaron rupturas grandes (grados II, III, IV). Hipoacusia leve y moderada fueron encontrados en 42% y 25% respectivamente. La localización no se encontró relacionada con la severidad de la pérdida auditiva. Encontramos una rata de cierre espontáneo muy baja (15,3%), entre aquellos que requirieron cierre quirúrgico la cadena oscicular se encontró integra en 64%. Conclusión: La mayoría de los pacientes afectados por explosivos que requiere contacto directo para su detonación (minas terrestres) presentarán perforaciones timpánicas grandes, con poca oportunidad de cierre espontáneo. A estos pacientes se les debería realizar cierre quirúrgico temprano para evitar complicaciones tardías...

The ear and its structures: basilar membrane, tympanic membrane and ossicles are the most sensitive organs injured during detonation of explosives (blast overpressure). The 38-92% of the tympanic membrane perforations due to explosives closes spontaneously; these remarkable differences areinfluenced by multiple factors such as size, location, type of weapon, among others. Treatment is still controversial: early miringoplasty, patching of the perforated drum or observation, have been all recomendated. Objective: To determine the severity of tympanic membrane perforations by explosives and its effect on hearing. Study design and methods: This is a retrospective study of soldiers injured in combat explosions in Colombia and treated at our institution. Data collected included age, gender, location and grade ofperforation, symptoms, ossicular damage, audiogram results (PTA), healing rates and type of explosive.Results: A total of 81 tympanic membrane perforations were found among these patients. Landmines was the most weapon used (57%) affecting our population. Most of the tympanic membranes (83,3%) had large ruptures (grade II, III, IV). Mild to moderate hearing loss was founded in 42% and 25% respectively. Location of the perforation was not related to severity of hearing loss. We found a very low spontaneous healing rate (15,3%). Among those who had surgical intervention, ossciles integrity was found in 64%. Conclusion: Most patients injured by explosives which require close contact to be detonated (landmines)may have large tympanic membrane perforations with little chance of spontaneous healing. These patients should be offered prompt surgical intervention to avoid later complications...

The morphology of central tympanic membrane perforations.

The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB. Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss.

Inner ear damage in children due to noise exposure from toy cap pistols and firecrackers: a retrospective review of 53 cases.

This retrospective study presents the findings of inner ear damage documented in 53 children exposed to impulsive sound emitted by toy weapons and firecrackers. There were 49 boys and four girls aged between four and fourteen years. Thirty-nine children were affected unilaterally while fourteen had bilateral hearing loss (total of 67 ears). Most of the hearing loss (>70%) was sensorineural high frequency hearing loss, while only nine out of the 67 injured ears had sensorineural mid frequency hearing loss. Seven children sustained a traumatic ear drum perforation. Dizziness or tinnitus was reported by twenty children, with pathological ENG findings in four of them. This paper re-emphasizes the possibility of inner ear damage in children from exposure to noisy toys.

Abnormal migration of ascaris into the middle ear.

Ascaris in the middle ear is very rare with very few cases having been reported. We report here two such cases with different presentations.

Un método simple para verificar la movilidad del estribo en los oídos perforados / A simple method to verify the stapes mobility in perforated ears

Los autores muestran un método sencillo y útil para verificar la movilidad del estribo, cuando éste es visible sea a través de una perforación o de una membrana timpánica muy adelgazada. Para ello utilizan una fuente sonora metálica que es golpeada con intensidad cerca del oído sano del paciente con lo que se produce el reflejo acústico y, dado que su eferencia es bilateral, puede observarse bajo el microscopio el movimiento del estribo