Injury to the tympanic membrane and ossicles may occur in many ways, including a blast injury, slap to the auricle, slagburn, waterskiing accident, and introduction into the ear canal of objects that penetrate the tympanic membrane. It may also occur in association with temporal bone fractures. A secondary infection is a common sequela of these injuries. Management depends on determining the probable extent of injury by careful history. Important questions to ask include the following: How and when did the injury occur? Has there been bleeding or drainage of clear fluid from the ear? Is there a hearing loss and, if so, how severe? Was dizziness experienced at the time of injury or later? It is essential to examine the ear with magnification, preferably the operating microscope, to determine the extent of injury and formulate a plan of treatment. A workup should include audiometric tests, including air, bone, and speech discrimination testing.

Nonpenetrating injuries, such as a slap to the auricle, a blast injury, or a waterskiing accident, usually heal without surgery; however, the area of injury should be cleared of wax, keratin, and loose hair that may have been imploded and that retard or prevent spontaneous healing. After cleaning the ear, torn segments of the tympanic membrane can be repositioned on a bed of Gelfoam and splinted with silk strips and cotton packing. Earlobe adipose tissue can be introduced as a medial onlay graft if the perforation is large.

Experience with 27 penetrating injuries reported in 1973 is representative of the continued experience with these cases (1). The most common cause of self-inflicted injury is the cotton-tipped applicator being used to clean the ear. The second most common occurs in children who introduce objects into their ears. About one-third of the lacerations of the tympanic membrane are associated with ossicular dislocations or fractures and most commonly involve the incus or stapes (Figs. 34.1, 34.2, 34.3 and 34.4). Fracture of the manubrium or neck of the malleus is less common (Fig. 34.5).