Temporal bone fracture

Temporal bone fractures may occur following severe blunt head trauma and sometimes involve ear structures, causing hearing loss or facial nerve paralysis.

A fracture of the temporal bone is indicated by Battle's sign (ecchymosis in the retroauricular region) and bleeding from the ear. Bleeding may originate from the middle ear through a damaged tympanic membrane or from a fracture line in the auditory canal. Blood in the middle ear gives the tympanic membrane a dark blue color. Leakage of cerebrospinal fluid from the ear indicates a communication between the middle ear and the subarachnoid space. Longitudinal fractures may extend through the middle ear and rupture the tympanic membrane; they cause facial paralysis in 15% of cases and rarely cause sensorineural hearing loss. Delayed complete facial paralysis indicates facial nerve edema without damage. Conductive hearing loss may occur due to disruption of the connection of the auditory ossicles.

Transverse fractures cross the facial canal and cochlea and almost always result in facial nerve paralysis and permanent sensorineural hearing loss.

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Diagnosis and treatment of temporal bone fracture

If a temporal bone fracture is suspected, it is recommended to urgently perform a CT scan of the head with special attention to the area of the suspected injury. Audiometry is necessary for all patients with temporal bone fractures, although it is not always necessary to perform it urgently. The Weber and Rinne tuning fork tests make it possible to differentiate conductive hearing loss from sensorineural hearing loss.

Treatment is aimed at eliminating facial nerve paralysis, deafness and liquorrhea. Facial nerve paralysis occurring immediately after an injury indicates severe damage, which requires revision and, if necessary, end-to-end suturing of the nerve. Delayed facial nerve paralysis is almost always treated conservatively using glucocorticoid suppositories. Incomplete facial nerve paresis that develops immediately after an injury or after a period of time is also restored in the vast majority of cases.

Conductive hearing loss requires restoration of the connection between the auditory ossicles within a period of several weeks to several months after the injury. The results of treatment are usually good. Sensorineural hearing loss is permanent in most cases, and there are no therapeutic or surgical treatments. However, in rare cases of fluctuating sensorineural hearing loss, a trial tympanotomy is indicated to search for a perilymph fistula.

Patients with temporal bone fractures and CSF leakage should be hospitalized due to the high risk of meningitis. CSF leakage usually stops spontaneously within a few days, although in some clinical situations lumbar drainage or surgical suturing of the defect may be required.

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