Middle/Inner Ear and Temporal Bone Trauma

8.5.1 How are temporal bone fractures classified? Draw the “prototypical” fracture lines and their relationship to important temporal bone structures.

8.5.2 Longitudinal vs. transverse fractures: Which is more common? What do you expect to see on otoscopic exam? What kind of hearing loss is associated with each? What is their association with CN VII injury?

8.5.3 You are called to the Trauma Unit for a patient who suffered blunt trauma to the head who now has blood draining from the ear. On exam, you see an ear canal laceration and a tympanic membrane perforation. What does the patient's CT scan show? What is your initial management? What is the likelihood of spontaneous healing of the tympanic membrane perforation?

8.5.4 How do you diagnose perilymphatic fistula? What is your initial management? What are indications for surgery? What is the prognosis for hearing and vesibular recovery in these patients after surgery?

8.5.5 A patient presents to the ER at 1 AM after being “pistol whipped” on the side of his head. He complains of severe hearing loss and vertigo with nystagmus and a tympanic membrane perforation on exam. Do you call in Dr. (your otologist) from his warm and cozy bed for an immediate exploration? What are you likely to find?

8.5.6 Your junior resident calls you from the Trauma Unit. He is evaluating an otherwise stable patient with complete ipsilateral facial nerve paralysis after being hit in the back of the head with a bat. What does his CT scan show? What do you tell him to do? 

8.5.7 How do you diagnose traumatic CSF otorrhea? Do you start antibiotics? What is your initial management? What if it persists?

Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures. Am J Otol. 1997 Mar;18(2):188-97. PMID:9093676

8.5.8 Discuss the management of traumatic tympanic membrane perforations. When is surgery indicated?

8.5.9 Discuss the indications and outcomes for surgical exploration of complete and incomplete facial nerve paralysis after blunt trauma with a temporal bone fracture.

Nash JJ, Friedland DR, Boorsma KJ, Rhee JS. Management and outcomes of facial paralysis from intratemporal blunt trauma: a systematic review. Laryngoscope. 2010 Jul;120(7):1397-404. PMID:20564723

8.5.10 A 20 year-old male is admitted to the Trauma Unit after a GSW to the head. He was found obtunded in an alley, but with stable vital signs. There is no other information. You are called because he is bleeding profusely from the ear. What do you want to do? (hint…do not forget ABC’s!)