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Fracture of the temporal bone
Last reviewed: 23.04.2024
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Fractures of the temporal bones are possible after severe blunt head trauma, and sometimes they involve ear structures, accompanied by hearing loss or paralysis of the facial nerve.
The fracture of the temporal bone is indicated by the Battle symptom (ecchymosis in the behind-the-bone region) and bleeding from the ear. Bleeding can come from the middle ear through the damaged eardrum or from the fracture line of the auditory canal. The blood in the middle ear gives the eardrum a dark blue color. The flow of cerebrospinal fluid from the ear indicates the presence of a communication between the middle ear and the subarachnoid space. Longitudinal fractures can pass through the middle ear and rupture the eardrum; they cause paralysis of the facial nerve in 15% of cases and occasionally cause neurosensory hearing loss. The delayed complete paralysis of the facial nerve indicates its edema without damage. Conductive hearing loss may occur due to rupture of the connection of the auditory ossicles.
Cross fractures cross the facial canal and cochlea and almost always lead to paralysis of the facial nerve and persistent neurosensory hearing loss.
[Diagnosis and treatment of a fracture of the temporal bone
If you suspect a fracture of the temporal bone, it is recommended to perform an emergency CT scan of the head with special attention to the area of the alleged damage. Audiometry is necessary for all patients with fractures of the temporal bone, although it is not always necessary to perform it urgently. Weber's and Rinne's tuning tests make it possible to differentiate conductive hearing loss from neurosensory.
Treatment is aimed at eliminating paralysis of the facial nerve, deafness and liquorrhea. The paralysis of the facial nerve that occurs immediately after the injury testifies to its severe damage, in which the revision and, if necessary, the end-to-end nerve stitching is shown. The delayed paralysis of the facial nerve is almost always cured conservatively with the use of suppositories with glucocorticoids. Incomplete paresis of the facial nerve, which developed immediately after the trauma or after a period of time, in most cases is also restored.
With conductive hearing loss it is necessary to restore the connection of the auditory ossicles within a period of several weeks to several months after trauma. The results of treatment are usually good. Sensorineural hearing loss in most cases is permanent, therapeutic or surgical methods of treatment do not exist. However, in rare cases of fluctuating sensorineural hearing loss trial tamponotomy is shown for the search for perilymphal fistula.
Patients with fractures of the temporal bone and cerebrospinal fluid are subject to hospitalization because of the high risk of meningitis. The flow of cerebrospinal fluid usually stops spontaneously for several days, although in some clinical situations lumbar drainage or surgical suturing of the defect may be required.
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