HNN ear sgd

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Head & Neck Module Small Group Discussion for the Ear and Temporal Bone Student Guide The temporal bone is an extremely important part of the body, not only because it contains vital sensory organs and helps protect the brain, but also because it is traversed by vascular structures that supply key areas of the central nervous system and by neural structures that provide important cranial nerve functions. This session will illustrate the myriad problems that may occur when the temporal bone is affected by pathology. Learning Objectives: At the end of this session, the learner must be able to: 1) Describe the signs and symptoms of a temporal bone fracture 2) Explain the anatomical basis for injuries that may occur in a temporal bone fracture 3) Explain the physiological basis for the hearing loss and the findings on clinical testing of hearing 4) Explain the physiological basis for the vertigo and the findings on clinical testing of the vestibular balance system 5) Discuss the treatment options for the different injuries that may occur in a temporal bone fracture 6) Discuss the societal issues (general safety, economic, etc.) that may be involved in the proliferation of motorcycles as a form of transportation in Metro Manila Case History: A 35-year old male motorcyclist suffered a left-sided temporal bone fracture when he was thrown from his motorcycle after it collided with a taxicab. He was immediately transported to the emergency room of The Medical City, where he was examined by the ER physicians and the otolaryngology resident-on-call. Although the man was conscious and communicable, he complained of severe dizziness described as a whirling sensation, and preferred to lie still with his eyes closed. Clinical examination revealed the following findings: 1) Bilaterally intact tympanic membranes with evidence of slightly reddish middle ear fluid in the left ear 2) Dripping of clear fluid from the left nostril when the patient leans forward 3) Weber test : lateralizes to the right ear 4) Rinne test : AC>BC in right ear, ACBC ears Normal Sensorineural loss in Sensorineural loss in left right Conductive loss in left Combined loss : conductive and sensorineural loss in left

Rinne left BC>AC

Rinne right BC>AC

Combined loss : Conductive loss in right conductive and sensorineural loss in right Combined loss in right Combined loss in left and and conductive loss on conductive loss on right left

Rinne both BC>AC


In relation to the patient 1) Weber test : lateralizes to the right ear 2) Rinne test : AC>BC in right ear, AC But LTO is inefficient and problem of red tape/corruption In line with this, stricter drivers' education should be implemented. > Drivers education as a priority. Go beyond the 2-3 hours classroom lesson; ask the help of NGO to augment LTO Punish the traffic enforcers who violate the very traffic rules that they are supposed to enforce > Very people who enforce the traffic rules often have a limited knowledge and understanding of what they are supposed to enforce. Change in infrastructure > Accommodate for growing number of motorcyclists by creating motorcycle lanes

Establish specific set of rules for motorcyclists Mandatory motorcycle insurance Some practical guidelines for riders: Ride assuming that you and your motorcycle are totally invisible to motorists. Leave plenty of space in front and back and to the sides from all other vehicles. Anticipate trouble situations and know what to do when you see them. Beware of motorists turning left in front of you at intersections. This is a leading cause of injuries to motorcycle riders. Slow down as your motorcycle enters an intersection and be prepared to make an evasive maneuver if necessary. Never drink or take drugs and try to ride a motorcycle. Dont ride if you are on medication that makes you sleepy. Avoid riding at night. Beware of riding your motorcycle into sun glare. Do not give in to road rage and try to get even with another rider or motorist. If someone is tailgating you, either speed up to open more space or pull over and let them pass.