Temporal Bone Fracture

Expected Presenting Complaints

• "I've hit my head!"
• I feel like I've lost some hearing
• I hear a ringing sound
• numbness on side of face
• dizziness

Expected Medical History

• Trauma to the head

Expected Social History

• Athlete (football, Motor Cross)
• Motor Vehicle Accident
• Dare Devil..maybe drinking?

Expected Signs on a Physical Exam

• Possible hemotympanum (blood behind TM)
• signs of trauma to head
• bruising
• bleeding

Longitudinal

• longitudinal fractures are more common with Temporal Bone fractures
• 70-80% in most case cases are Longitudinal
• conductive hearing loss, facial paralysis, incudostapedial dislocation

Such a fracture typically originates from a blow to the temporoparietal portion of the skull, with inferior propagation of the fracture line through the mastoid into the lateral wall of the middle ear, passing behind, through, or in front of the external auditory canal.

Transverse

• Transverse fracture line is less commmon 20-30%
• can cause SNHL
•  blows to the frontal bone or occiput
• These fractures normally cross the fallopian canal and otic capsule.

Expected Audiological Test results

• AC/BC typically results in a conductive HL
• Immitance tests reveal AD or type B
• Acoustic Reflexes elevated or absent 
• Reflex Decay absent
• Word Rec at raised volume good

Audio Results

• OAE's typically are present or reduced depending on injury
• ABR testing shows a conductive hearing loss (delayed absolute latencies)

Expected Radiology Test Results

• CT scans to determine damage and location
• Also use CT imaging to determine type of fracture 
• MRI can determine fracture and presence of blood or CSF

Expected Laboratory Results

• If there is drainage tests can be done to determine if it is CSF

Treatment is based on managing facial nerve injury, hearing loss, vestibular dysfunction, and CSF leakage. If immediate facial nerve paralysis occurs with loss of electrical response, surgical exploration may be warranted. Delayed-onset or incomplete facial paralysis almost always resolves with conservative management, including use of corticosteroids, which are gradually tapered.

cerebrospinal fluid (CSF) leak, CSF fistula, meningitis, and post-traumatic cholesteatoma may also result w/surgery

Audiology Outcomes/treatment

• surgery is an option to reconstruct ossicles/remove scar tissue
• outcome is generally good
• hearing aids are an option as well

Expected Long term Sequelae

• In our case the prognosis was good
• It varies on a case by case situation
• Medical attention and treatment in a hospital is important
• Complications can arise after an invasive surgery
• Hearing aids are an option for treating hearing loss