![]() Here, we present a case of CAM with remote history of close head trauma and cerebrospinal fluid rhinorrhea for years who was found to have base of skull (BOS) defect on imaging of skull. The role of internist is to provide holistic management in these patients which includes not only antimicrobial treatment but also timely referral to surgical specialties if required as well as vaccination to prevent further episodes. Knowledge about pathophysiological, anatomical, and microbiological context of community-acquired PTM is required in order to manage these patients. Therefore, meticulous clinical assessment is necessary to identify cases of community-acquired PTM. However, closed-head trauma can be associated with community-acquired meningitis (CAM), and this history can often be missed especially if it is remote or trivial in nature. Hence, internists do not often come across these patients. ![]() In other patients, a hearing aid may be considered.Most cases of post-traumatic meningitis (PTM) occur following immediate head trauma or neurosurgical procedures. For some patients, surgery can be performed to reconstruct the hearing bones. This can occur after either blunt or penetrating trauma to the ear. This results in a conductive hearing loss. Ossicular dislocation occurs when the three middle ear hearing bones (malleus, incus, stapes) are no longer in continuity. Less commonly, patients may require surgery to repair the CSF leak. Some patients require a lumbar drain, which is a tube that decompresses the CSF through the back. This can manifest as dripping of thin clear fluid from the ear, or out of the nose. If the facial paralysis occurs on a delayed basis (hours or days after injury) then often the nerve is swollen and not fully cut, and conservative management without surgery is recommended.ĬSF leak can occur after temporal bone fracture since the "ceiling of the ear" shares the same bone as the "floor of the brain". This decision is often based on the specific anatomy seen on the patient's CT scan. If the facial paralysis occurs immediately with the temporal bone fracture, sometimes surgery may be helpful to repair a cut nerve. The first three causes of hearing loss result in a conductive hearing loss while fracture through the inner ear causes a sensorineural hearing loss.įacial paralysis can occur when the facial nerve is cut or swollen due to head injury. The associated hearing loss can result from blood building up behind the ear drum, from ear drum rupture, from dislocation of the middle ear hearing bones, or from fracture through the inner ear. Temporal bone fractures can potentially cause complications including hearing loss, dizziness, facial paralysis, or leaking of cerebrospinal fluid (CSF). In head trauma, this bone can become fractured, and is diagnosed using a CT scan. The temporal bone is one of the many bones that make up the skull. In these cases, an ear specialist may recommend surgery. Some perforations do not heal on their own or can cause cholesteatoma to form. Others can predispose to infection and require treatment with antibiotic ear drops or pills. Many traumatic ear drum ruptures heal on their own without the need for surgery. The ear drum can rupture when foreign objects pierce it through the ear canal, with rapid pressure changes to the ear, or with blunt force trauma to the temporal bone. Tympanic membrane perforation (Ear drum rupture) A bolster dressing is often placed to prevent the blood from re-accumulating. If diagnosed early, treatment typically involves opening the pocket and draining the blood. The pocket of blood will feel soft, like a water balloon. This causes the outer ear to look swollen. Here are a few:Īn auricular hematoma occurs when a pocket of blood collects under the skin of the outer ear. Trauma to the ear and temporal bone (ear canal, ear drum, middle ear bones, inner ear) can result in different types of injury.
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