The temporal bone or skull bone that contains part of the ear canal, middle ear and inner ear can end up damaged. A temporal bone fracture is usually due to a direct blow to the head.
A temporal bone fracture can result to a number of injuries to the inner ear anatomy. The injuries include eardrum rupture and impairment to the ossicles, cochlea, vestibular apparatus or the facial nerve.
What are the indications?
There is pain and often bleeding from the ear, blood behind the eardrum or bruising of the skin at the back of the ear. The other symptoms and complications usually vary depending on the location of the fracture.
Some individuals have facial paralysis on the side of the fracture. This can develop right away or after some time which can be mild or severe.
Severe hearing loss is another symptom. This can occur from damage to the ossicles that connect the eardrum to the inner ear or from damage to the cochlea or the nerve that leads to the cochlea.
Once the vestibular apparatus is damaged, the individual might feel as if he/she or the surroundings is spinning (vertigo) or have balance issues. Oftentimes, the fluid from around the brain and spinal cord drains via the fracture and characterized as a clear fluid from the nose or ear. The drainage of this fluid indicates that the brain is exposed to a potentially serious infection from bacteria in the ear canal.
How is it diagnosed
The doctor will also test the hearing of the individual and whether there is facial paralysis. In case there are issues, further testing is carried out such as detailed hearing testing of the nerve responsible for controlling facial movement.
Management
Take note that treatment is only needed if the temporal bone fracture triggers other issues.
- For facial paralysis that is immediate and severe, surgery is required. If mild or delayed, a corticosteroid drug is given orally.
- If the hearing loss originates from damage to the ossicles, they are repaired surgically. The hearing loss that results from damage to the cochlea or its nerves is usually permanent.
- If the vertigo is due to damage that could not be surgically repaired, a benzodiazepine drug is given for some relief.
- If there is drainage of cerebrospinal fluid, it requires hospitalization. If the drainage does not stop on its own within a few days, surgery or insertion of a drain close to the spinal cord in the lower back might be needed to prevent infection.