Rethinking auricular trauma

OBJECTIVES/HYPOTHESIS: An unrecognized auricular hematoma can lead to a disfiguring deformity, the cauliflower ear, but it can be prevented with prompt and comprehensive management. Fine needle aspiration with pressure bandages remains the mainstay treatment but will occasionally fail. We review our experience with recurrent or recalcitrant auricular hematomas in terms of their pathophysiology and revision surgery. STUDY DESIGN: Retrospective chart review. METHODS: A review of patients undergoing surgical incision, drainage, and debridement secondary to recurrent auricular hematomas was conducted. Demographic data was collected, intraoperative notes were reviewed, and follow-up results were obtained. Our management included an open incision, aggressive debridement, and long term bolsters to the ear. RESULTS: Ten patients presented with a persistent auricular hematoma and deformity following outpatient management with either incision and drainage or fine needle aspiration. All were male with a mean age of 25 years, presenting for surgery on average 19 days following initial trauma. The location of the hematoma within this group was not limited to the potential space between the cartilage and perichondrium. The hematoma was clearly located within the cartilage itself and it is postulated that this is one of the primary reasons for initial failure. Following surgical incision and drainage there were no recurrences or complications. CONCLUSION: There is a select group of patients with refractory auricular hematomas that require more aggressive treatment over a fine needle aspiration. Open debridement is indicated for this group. The location of the hematoma, granulation tissue, and neo-cartilage is found to be within the cartilage itself rather than between the cartilage and perichondrium, thus explaining why a needle aspiration alone can be ineffective.     

External laryngotracheal trauma

Differences in acute external injuries of the larynx and cervical trachea between peacetime and war trauma were studied. Twenty-six patients with peacetime injuries and 39 patients with war injuries were retrospectively analyzed. The incidence of peacetime laryngotracheal injuries was 0.91% of the total number of patients hospitalized for head and neck injuries. In the groups of wounded in action (WIA) and killed in action (KIA) with head and neck war injuries, the incidence of laryngotracheal injuries was 4.8 and 6.2%, respectively. According to the type of the wound, blunt injuries were most common among peacetime and penetrating wounds among war injuries. There was no difference between peacetime and war injuries according to the wound localization. War wounds were more severe, caused more extensive local tissue and organ defects, were associated with a greater number of lesions to the neck and other body regions and more often required reconstructive surgical procedures than peacetime injuries. The mortality of war laryngotracheal injuries was two times greater than that of peacetime lesions (9 vs. 3.8%).     

Acute acoustic trauma

Acute acoustic trauma is a clinical condition with immediate persistent hearing loss after impulse or blast wave noise. This condition is not well recognized in occupational medicine and probably not even in otolaryngology. We report 52 cases of acute acoustic trauma including information concerning the traumatic event. Most cases occurred within military service and in the shipbuilding industry. Except for immediate hearing loss, many patients experienced tinnitus and some pain and hyperacusis. Relatively few patients report immediately. Most patients have been met by a nihilistic approach to therapy, in most cases due to the fact that patients report long after the trauma. The aim of the report is to focus attention on this clinical condition, since there is some indication that the final outcome may improve if patients are taken care of and treated early.     

CT in facial trauma

Recent advances in high resolution CT imaging have provided marked improvement in bone imaging. Complex facial fractures, especially those associated with craniocerebral or spinal injuries, are better and more safely assessed by CT. Degrees of comminution, previously grossly underestimated by conventional radiography, are more accurately assessed by CT. The transaxial axis remains the dominant modality and superbly demonstrates displacements. Complications to soft tissue structures (orbit, brain) are diagnosed at the time of study and provide information often not obtainable by other modalities. High resolution CT has become our definitive study of complex facial fractures involving the mid or upper thirds of the facial skeleton.     

Phenothiazine induced lingual trauma

A 34-year-old woman presented with an unusual and unfortunate combination of complications to a phenothiazine drug. Rhythmic protrusion of her tongue was not a problem until it became trapped outside of her oral cavity by spasm of the muscles of mastication. Massive edema with questionable viability of her tongue ensued. She presented as an airway as well as therapeutic management problem.     

Characteristics of the acoustic analyzer trauma in blast trauma due to mine explosion

Explosion barotraumas of the middle ear and neurosensory hypoacusis were observed in all examinees with ENT contusion. Acute neurosensory hypoacusis of any etiology is accompanied with stress which stimulates secretion of beta-endorphine showing adaptogenic, immunomodulating and anti-inflammatory properties. In patients with mine explosion trauma beta-endorphine was 2-2.5-fold higher than the basal concentration. Pharmacoacupuncture followed by electrostimulation of biologically active points improves acoustic function. Further target studies of current aspects of complex mine explosion trauma of the brain, acoustic and vestibular systems must be done.     

Head trauma and olfactory function

Olfactory impairment is a well-established sequela of head injury. The presence and degree of olfactory dysfunction is dependent on severity of head trauma, duration of posttraumatic amnesia, injuries obtained, and as more recently established, age. Deficits in smell can be conductive or neurosensory, contingent on location of injury. The former may be amenable to medical or surgical treatment, whereas the majority of patients with neurosensory deficits will not recover. Many patients will not seek treatment for such deficits until days, weeks, or even months after the traumatic event due to focus on more pressing injuries. Evaluation should start with a comprehensive history and physical exam. Determination of the site of injury can be aided by CT and MRI scanning. Verification of the presence of olfactory deficit, and assessment of its severity requires objective olfactory testing, which can be accomplished with a number of methods. The prognosis of posttraumatic olfactory dysfunction is unfortunate, with approximately only one third improving. Emphasis must be placed on identification of reversible causes, such as nasal bone fractures, septal deviation, or mucosal edema/hematoma. Olfactory loss is often discounted as an annoyance, rather than a major health concern by both patients and many healthcare providers. Patients with olfactory impairment have diminished quality of life, decreased satisfaction with life, and increased risk for personal injury. Paramount to the management of these patients is counseling with regard to adoption of compensatory strategies to avoid safety risks and maximize quality of life. Practicing otolaryngologists should have a thorough understanding of the mechanisms of traumatic olfactory dysfunction in order to effectively diagnose, manage, and counsel affected patients.