The Injured Ear - Ouch!

The injured ear is always accompanied by a story...

One of my medical assistants has a very challenging teenager. He mouths-off, swears, and is very disrespectful to his hard-working mother. Recently, in a spontaneous act of frustration, she slapped him across the face and accidentally hit his ear, instead of the mouth that was emitting four-letter words. Instantly, his hearing changed (albeit, temporary).

Child abuse or not...you be the judge. Did he deserve it? In my opinion, he did not. No child should be hit or slapped, no matter what emotional buttons they push. Adults must have the wisdom and constraints not to strike out physically at their kids (unless they are defending themselves).

Blunt traumas of the ear are one of the most common types of ear injuries. The sudden application of air pressure in the ear canal can occur from soccer and basketballs, wrestling with friends, a blast (from a firework or gun), or an open hand slap. A ruptured eardrum can even occur from a poorly-placed kiss. Blow in my ear and I will follow you anywhere, including the ENT.

Several years ago, I had a 12-year-old girl present to my office with blood coming out of her right ear. She said that a man in a ski mask ran up to her at the bus stop and slapped her ear and ran away into the woods. Yes. That happened. Her shifty-eyed father was not very interested in me calling the police to find this masked perpetrator, reminiscent of OJ Simpson's exhaustive search for the killer.

The bottom line was that he slapped her across the ear and ruptured her eardrum. She did recover physically from this injury, but the emotional scars of being abused by her Dad can go deep. I did call Child Protective Services, as required by law, because I have no idea if this was an isolated incident.

Trauma to the outer ear can also cause lacerations and severe bruising that can result in a cauliflower ear. Most minor lacerations of the auricle can be repaired, usually with perfect cosmetic results. It is not uncommon to have earrings ripped from a pierced ear, accidentally caught on something, or even pulled during an altercation. These, too, can be repaired. Last week, I sutured another teenager that had the crap beat out of him at school, sustaining a cut above his eye, the back of his head, and his outer left ear was bruised. His eardrum was intact, but the appearance of the outer ear is always a cause for concern.

An accumulation of blood in the outer ear (called a hematoma) can result in a permanent cosmetic deformity called a cauliflower ear, unless it is treated promptly. Left alone, the accumulated blood in the ear will be replaced by fibrous tissue and perichondritis (a cartilage infection). We really do not want our kids looking like Mike Tyson or Leon Spinks. (Mike and Leon...this is just a joke. Please don't hurt me) I typically refer outer ear hematomas to a plastic surgeon or ENT specialist so that this blood can be definitively drained and irrigated.

Another type of outer ear injury is the thermal injury. Growing up in a cold climate and not wanting to wear a hat with those furry earmuffs that would mess up my hair, I had some close calls with frostbite. When that icy snowball hits your ear, it feels like it could just snap right off the side of your head. Snow-boarders and skiers tend to show up at ERs during the winter season with some painful, cold-damaged ears. I remember seeing the photos of the doctor who survived that terrible Mt. Everest attempt. His outer ears were nearly gone.

If you are foolish enough to snowboard without a hat (let alone a helmet!) then you better learn some rapid-warming techniques to prevent outer ear thermal injuries. The prompt application of moist, warm (100-104 degree) gauze can prevent permanent damage. Injuries caused by heat are also relatively common. Burns, including sunburns, should also be treated promptly to prevent cosmetic damage.

Q-tip injuries are a weekly posting on the WebMD Ear Disorders Board. For some reason, people feel that wax is dirt that must be thoroughly removed. The probe their ear canals with bobby pins, toothpicks, and cotton-tipped swabs. Granted, earwax is not the most appealing substance on this planet, and no one really likes to see it dripping out of your ear, it is NOT dirty. Short of a public relations campaign to restore the damaged image of earwax, they only thing I can do is continue my personal campaign against people using Q-tips for this purpose. Q-tips do perforate eardrums from time to time -- a very painful experience.

A teen was cleaning her ear a month ago when the bathroom door was suddenly opened by an impatient sibling needing to urinate. The door struck her elbow and the Q-tip plunged deep in her ear canal, resulting in a very impressive rupture that took over a month to heal. Fortunately, there was not permanent damage.

Children do other stupid things. I had the class clown in my trauma room one day with blood pouring out of his ears. Apparently, as the story went, he had a sharpened pencil in each ear, dancing around in an effort to impress one of the girls in his class. Not amused by this display, the girl slapped one of those protruding pencils and jammed it through the eardrum into the middle ear, damaging those tiny ear bones. Had there been a bit more force, the pencil may have killed him. This even makes MY ear hurt telling you about it, but a skillful ENT repaired the damage.

So, the outer ears are more important than just holding up our glasses, or providing a place to hand earrings. It is okay to nibble on them from time to time, but otherwise, treat them with respect.