CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
16-year-old with Head Trauma
A 16-year-old presented to the Emergency Department (ED) as a trauma patient after he fell from the roof of a house he was helping to repair. Witnesses stated he landed on his head and had a brief loss of consciousness. He was brought in via ambulance and noted by first responders to have a GCS of 14. In the ED, his primary survey revealed a patent airway, easy respirations, normal pulses, moved extremities spontaneously, and had equally reactive pupils. His secondary survey demonstrated a scalp hematoma to the right temporal-parietal area. His Wispr digital otoscope image is attached below.
Which additional findings are associated with the etiology of this teenager’s injury?
A. Bruising behind the ear and around the eyes.
B. Nasal drainage
C. Hearing loss
D. All of the above
D. All of the above
This patient’s Wispr digital otoscopic exam demonstrates a hemotympanum, or blood in the middle ear space. A common cause for this finding, particularly from blunt force, is a fracture to at least one of the bones comprising the base of the skull. Basilar skull fractures often involve the temporal bone and should be highly suspected in a patient with blunt injury and any of the other associated findings, including: retroarticular ecchymosis (ie Battle’s sign), periorbital ecchymosis (racoon eyes), suspicious fluid from the nose or ear (cerebrospinal fluid leak), cranial nerve weakness, or hearing deficit.
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