Of all the areas of the body, the ear is particularly vulnerable to sports-related trauma and damage because of its central location, minimal soft tissue coverage and nonrigid skeleton. Soft tissue injuries, such as lacerations, abrasions and contusions, occur frequently; less common are temporal bone fractures, ear drum perforations, infections and frostbite. Depending on the sport and the type of injury, some injuries can be managed with home care or by a family practitioner while others may require the attention of a specialist.
Boxing, wrestling, skateboarding, skiing, ice skating, roller skating, biking, motocross and more – athletes of these sports share the common risk of receiving a hard knock on the head. When this occurs, one of the most common injuries to the ear, an auricular hematoma, may result. A blow to the ear can cause a separation of the ear skin and cartilage lining and blood can accumulate in the space created by the separation. It will appear as a firm, bruise-like, distorting collection of blood in the upper portion of the ear.
Early treatment is far less complicated than treating a hematoma that has been allowed to grow, or recurring injuries to the same spot. If the hematoma is still small, it may be aspirated with an 18-gauge needle and dressed with a compress bandage. Larger or recurrent injuries require an incision to drain. If treatment is inadequate, or worst of all, there is no treatment at all, a hematoma may decay in cartilage and cause an abnormal growth known as cauliflower ear.
Another possibility as a result of hard knocks to the head is a temporal bone fracture or concussion. Unlike auricular trauma, temporal bone fractures and labyrinthine concussions result from blunt trauma to the head and not necessarily direct forces on the ear. While the use of helmets and padding has dramatically reduced the frequency of such injuries, significant injuries still occur.
Fractures of the temporal bone may take a variety of paths and often involve the inner ear. People with an inner ear injury may experience hearing loss, have lacerations in the ear canal and will often have blood behind the ear drum. Fractures through the inner ear may cause severe nerve damage, vertigo and even facial paralysis. Unless this last symptom is present immediately after the injury, treatment of temporal bone fractures is generally conservative – observation and pain relief. If facial paralysis is present immediately after the injury, a CT scan or other electrodiagnostic test may be indicated.
Labyrinthine concussions appear similar to temporal bone fractures and can only be differentiated by a CT scan. A person with a labyrinthine concussion has an anatomically intact inner ear that is malfunctioning because of a significant blow to the head. The symptoms generally include a combination of headache, dizziness and mental disturbance following significant head trauma. The dizziness and nausea associated with labyrinthine concussions typically resolve themselves over six weeks but in some cases symptoms may persist longer.
You may not have ever considered a blow to the ear from air a major threat to your hearing health; however, when outside air is pressing or decompressing against your ear at rapidly changing rates, trauma can result. Rapid changes in air pressure of the sort that skydivers and scuba divers experience may result in barotrauma. As atmospheric pressure increases, the difference in the pressure between the atmosphere and the middle ear becomes greater. The pressure in the external ear canal increases, causing an inward bulge in the tympanic membrane which will continue until atmospheric pressure and middle ear pressure are equalized. The resulting sensation is fullness, pain and possibly hearing loss. If the pressure in the middle ear does not adjust to atmospheric pressure, damage to the inner ear or tympanic membrane may occur.
Barotrauma is typically treated conservatively with observation and pain relief. Occasionally, use of a hyperbaric chamber or surgery may be needed in an attempt to reduce symptoms. Hyperbaric oxygen therapy entails being placed in a specially designed airtight chamber. The pressure in the chamber is increased while the patient breathes 100 percent oxygen. The increased pressure in the chamber simulates the pressures during the scuba dive and gives the inner ear a second chance to re-equilibriate to normal pressure over a slower time frame than that of rising to the surface at the end of a dive.
Water Resistant not Water Proof
Swimming, surfing, water polo, diving and more – water sports that continuously bathe the ear canal with cold water can cause numerous problems ranging from ruptured ear drums and bone spurs to the common swimmer’s ear, or otitis externa.
The most likely scenario for an ear drum, or tympanic membrane, rupture is the ear being struck by a strong wave or hitting the water with sufficient force. This can happen during surfing or when sailing small watercraft (windsurfing). Using earplugs during water sports may reduce the risk of tympanic membrane perforation. The symptoms of tympanic membrane rupture may be ear pain, hearing loss, tinnitus (ringing or other noise in the ear), vertigo and even bloody drainage. Most ruptures heal with time and infections are rare but a short course of topical antibiotic therapy may be advised to prevent infection. A recuperating ear needs to remain free of foreign material, including water, and water activities that lead to the rupture should be suspended until the perforation heals.
Chronic exposure to cold water can result in auditory exostoses, bony outgrowths that arise from the temporal bone and protrude into the ear canal. They usually are asymptomatic but can cause hearing loss, frequent ear infections and occasionally, pain. Exostoses usually occur simultaneously in both ears. The presence and severity of auditory exostoses directly correlates with the amount of time the patient spends in the water. Surgery is the only treatment for exostoses and usually it is reserved for people with severe, symptomatic cases with hearing loss.
Trauma, chronic exposure to moisture, and exostoses make outer ear infections a common ailment among cold water sports. Even the back yard water enthusiast is susceptible to the pervasive swimmer’s ear. These infections are usually caused by water stagnating in the external auditory canal. Trauma from foreign bodies and wave pressure also can contribute to infection. Most cases of outer ear infections, which cause severe pain in a red and irritated ear canal, can be treated with topical antibacterial drops for five to seven days although some patients may need longer treatment. Outer ear infections are preventable with diligence in drying the ears after exposure to water. Taking a few minutes to lie on one’s side to let water fall out of the ear canal can spare days of painful irritation.
Although uncommon, outdoor winter sports such as sledding, skiing and simple snowman-building can cause damage to the ear through frostnip and frostbite. These completely preventable injuries will not occur with warm ear covering and frequent breaks to go inside and warm up.
Frostnip occurs when skin surfaces, such as the ear, are exposed to an environment cold enough to freeze the superficial skin. These prominent exposed surfaces become blanched and develop altered sensation. Frostbite occurs when there is either a partial or a full thickness freezing of the deeper skin. The frozen surfaces appear white and feel soft. Both frostnip and frostbite are treated by rapidly rewarming the affected body part with lukewarm water. Thawing generally takes less than an hour and is complete when the tissue swells and flushes abnormally red due to the irritation and dilation of the capillaries. Pain is a common symptom during rewarming and often necessitates pain control with narcotics. Blistering may occur within 24 to 48 hours after frostbite.
Ear trauma from toxic noise; direct forces to the ear as seen with hematomas, lacerations or fractures; and rapid changes in the external environment, as seen with frostbite or barotraumas, are very real possibilities for athletes and even fans of many different sports. These dangers should not keep you from enjoying your favorite sport or allowing children to learn and engage in sports. They should prompt you to take precautions and prevent injury. Should injury occur despite precautions, accurate diagnosis and treatment will mean quicker recovery and fewer long-term complications.
