Ear Nose & Throat Haematoma Update

Ear, nose and throat are closely related. So, ENT fractures can never be considered as mild injuries. Ear Nose and Throat Hematomas in any of these parts can cause serious troubles for the other two parts.

One of the most common injuries to the nose is a nasal fracture or broken nose. This usually is caused by blunt trauma to the nose (as in case where a baseball or elbow hits it). Swelling, bruising and bleeding may occur.

A nasal fracture is usually repaired by a closed reduction. This means that the nose is relocated into a normal position without an incision. Often times, it is difficult to evaluate a nasal fracture immediately after the injury due to the swelling that is present. Therefore, an ear, nose and throat specialist should do an evaluation about 4 to 5 days after the injury. Repair is best done within seven to ten days of injury.

You have to get your nose evaluated and examined immediately after the injury to ascertain whether septal hematoma is not present. Hematomas is a collection of blood that needs to be drained out. A septal hematoma however is the collection of blood in the septum, the partition of the nose that needs to be drained. If this is not done an abscess (infection) and a loss of cartilage may result.

The ear drum (tympanic membrane) can tear as a result of an explosion or a slap to the ear. In areas popular for water sports such as Florida, this injury is more commonly seen as a result of water-skiing or wake boarding. The eardrum can also be cut (perforated) because of insertion of an object such as a Q-tip, stick, or pen. Most of the time (that is 90% of the times), the holes heal without surgical treatment. If they do not heal, TYMPANOPLASTY may be required.

Tympanoplasty is a process to repair the ear drum with a patch of muscle tissue. It is important to have an ear, nose, and throat specialist examine the ear and evaluate the hearing as trauma to the ear can cause hemotympanum (blood behind the ear) or a disconnection of the ear bones causing hearing loss. Trauma to the ear may cause a fracture through the ear and hearing organ resulting in hearing loss, disruption of the ear bones, spinal fluid leak or facial nerve injury.

Traumatic injuries also occur within the mouth, especially in children. One of the most common is a soft palate (roof of mouth) laceration. These are cuts or punctures on the roof of the mouth caused by pencils, pens, and toothbrushes.

Therefore, trauma to the neck is one of the more common causes of death in an injured patient. These vital structures include the airway (larynx and trachea), large blood vessels (carotid arteries and jugular veins, among others), the esophagus (tube that goes from the mouth to the stomach), the spinal cord, and many other nerves that are important for breathing, swallowing, arm movement, voice and sensation. The neck also contains glands (thyroid, parathyroid, and salivary) and other structures that are also critical for normal body functioning.

Because Ear Nose and Throat Hematomas are serious, Evaluation starts with the basic ABCs (airway evaluation, check for breathing and check circulation) of resuscitation. Any patient with trauma to the neck will need to be evaluated to make sure the airway is able to deliver air to the lungs.

If the airway is compromised, a by-pass airway must be created either through an endotracheal tube (tube through the mouth), emergency cricothyroidotomy (temporary hole in the neck under the voice box), or a TRACHEOTOMY (a temporary tube through the neck into the breathing tube). Air (oxygen) is then delivered to the patient. Once adequate breathing is assured, any visible bleeding is controlled.