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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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Is Fall And Hitting Left Mastoid On Rock Followed By Small Knot, Bruising, Pain And Hearing Heartbeat In Left Ear Serious?

My son slipped in the shower and hit his L mastoid process on a built in rack in the shower stall. He instantly had a small knot (about 1 cm diameter) and bruising to mastoid area behind L ear. He denies any nausea, but he says his he has pain to the L side of head and can hear his heartbeat in his L ear (but not his R). Should I have him assessed tonight or watch him over night for any worsening signs? Thank you.
posted on Mon, 14 Apr 2014
Twitter Sat, 23 Jan 2016 Answered on
Twitter Mon, 25 Jan 2016 Last reviewed on
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Neurologist, Surgical,  's  Response
Hello. Thanks for asking from HCM.



I can understand your concern. The type of head injury which needs immediate attention is dangerous head injury. There are few signs, presence of which establish its diagnosis. You should observe for these signs

: vomiting
: loss of consciousness more than 5 minutes
: decreasing consciousness
: bleed through nose/ear/throat
: fits
: persistent headache not responding to painkillers
: loss of memory, focal weakness of any limb, speech problem
: altered behaviour

If you observe any of above sign, you must consult ER as soon as possible. The doctor might advise CT head to rule out fracture or bleed in brain. Fracture is usually treated by conservative treatment while bleed may require surgical evacuation.

If no above sign, you can observe him at home. My only concern is sound of heartbeat in his left ear. It could be due to bruise on same side which causes increased blood flow in same area and feeling of pulsatile sound in ear.

Another rare but serious reason could be "traumatic dural artery-venous" fistula. It is establishment of communication between artery and vein resulting into pulsatile sound in ear, vertigo, sometimes rupture and bleed in brain.
It can be ruled out by CT angiography of brain vessels. You have to consult doctor for it. After confirming diagnosis, it is treated by blocking of communication.
If his symptom persists and no relief even after applying icepacks, taking painkiller like Diclofenac sodium, then you should consult doctor for evaluation.

Hope it will help you.


Thanks.

Take care.
Dr Ishu Bishnoi
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Is Fall And Hitting Left Mastoid On Rock Followed By Small Knot, Bruising, Pain And Hearing Heartbeat In Left Ear Serious?

Hello. Thanks for asking from HCM. I can understand your concern. The type of head injury which needs immediate attention is dangerous head injury. There are few signs, presence of which establish its diagnosis. You should observe for these signs : vomiting : loss of consciousness more than 5 minutes : decreasing consciousness : bleed through nose/ear/throat : fits : persistent headache not responding to painkillers : loss of memory, focal weakness of any limb, speech problem : altered behaviour If you observe any of above sign, you must consult ER as soon as possible. The doctor might advise CT head to rule out fracture or bleed in brain. Fracture is usually treated by conservative treatment while bleed may require surgical evacuation. If no above sign, you can observe him at home. My only concern is sound of heartbeat in his left ear. It could be due to bruise on same side which causes increased blood flow in same area and feeling of pulsatile sound in ear. Another rare but serious reason could be traumatic dural artery-venous fistula. It is establishment of communication between artery and vein resulting into pulsatile sound in ear, vertigo, sometimes rupture and bleed in brain. It can be ruled out by CT angiography of brain vessels. You have to consult doctor for it. After confirming diagnosis, it is treated by blocking of communication. If his symptom persists and no relief even after applying icepacks, taking painkiller like Diclofenac sodium, then you should consult doctor for evaluation. Hope it will help you. Thanks. Take care. Dr Ishu Bishnoi