Temporal Bone Fracture

Question 1

What is it?

Answer 1

can be longitudinal or transverse fracture

longitudinal - more common can cross the internal acoustic meatus causing damage to the auditory and facial nerves

Question 2

how does it present?

Answer 2

injury mechanism 
hearing loss 
facial palsy 
vertigo 
CSF leak 
associated injuries 
bruising - battle sign 
condition of TM and ear canal 
VII 
hearing test

Question 3

how is it managed?

Answer 3

ENT - only should be involved if there is immediate facial nerve palsy - the nerve palsy is often delayed as polytrauma
may need facial decompression - if no recovery and EMG studies
may need to manage CSF leak, most settle but may need repair
may need hearing restoration - either hearing aid or ossiculoplasty

Question 4

what is sudden sensorineural hearing loss?

Answer 4

an emergency different to a conductive hearing loss

Question 5

how is sudden sensorineural hearing loss investigated?

Answer 5

weber test

Question 6

how is sudden sensorineural hearing loss managed?

Answer 6

steroids 1mg/kg and consider intratympanic treatment