Temporal bone fractures occur after heavy, blunt head trauma and sometimes also affect structures of the ear, which can lead to hearing loss, vertigo, to balance problems and facial palsy.
Temporal bone fractures are suspected because of
Temporal bone fractures occur after heavy, blunt head trauma and sometimes also affect structures of the ear, which can lead to hearing loss, vertigo, to balance problems and facial palsy. are temporal bone fractures suspected because of fighting characters (postauricular ecchymosis) bleeding from the ear, the bleeding can from the middle ear (Hämotympanum) via a perforated eardrum or a fracture line in the ear canal originate (Traumatic tympanic membrane). When Hämotympanum the eardrum appears discolored blue-black. A Liquorotorrhö indicates a connection between the middle ear and the subarachnoid space. Temporal bone fractures are classified according to the location in relation to the longitudinal axis of the temporal bone area of ??the temporal bone. Longitudinal fractures account for 70-90% and transverse fractures 10- 30% of temporal bone fractures. Some fractures may have characteristics of both patterns. Longitudinal fractures can spread to the middle ear and rupture the eardrum. In 20% of cases there is a facial palsy, rarely a hearing loss occurs (usually a conductive hearing loss). Transverse fractures Fallapio cross-channel, and the otic capsule, which triggers a facial paresis in about 40% of patients, and sometimes have a hearing loss (usually sensory) caused, and a vestibular dysfunction (z. B. dizziness, vertigo). Rarely, a fluctuating sensory hearing loss and vestibular dysfunction due to a perilymph fistula at a temporal bone fracture. An immediate full facial paralysis may be signs of a severed or crushed Fazialisnervs while a delayed complete facial paralysis usually indicates edema within an intact nervous. Diagnostic computed tomography assessment of hearing and Fazialisnervfunktion Suspicion of temporal bone fractures, immediate CT with special attention to the temporal bone is recommended. The tuning fork tests by channel and Weber assist in the initial clinical study in conscious patients to differentiate between a conductive and a sensorineural hearing loss. However, the formal audiometric testing for all patients with temporal bone fractures is required. When a facial paralysis is present, an electrical test of the facial nerve is displayed. Treatment must be expected with an injury to the facial nerve, hearing loss, a vestibular and a spinal fluid leak. The treatment focuses on the violation of the facial nerve, the hearing loss and the Liquorotorrhö. If immediate facial paralysis occurs with a loss of electrical reaction, surgical exploration may be justified. A delayed onset of complete or incomplete facial palsy should be treated almost always conservative by tapering of corticosteroids. A conductive hearing loss makes the reconstruction of ossicular weeks or months needed after the trauma. Here are expected good results. A neural hearing loss is typically permanent, listening can be improved either by medication or by surgical procedures. In the rare cases of a fluctuating neural hearing loss an exploratory tympanotomy is performed to search for a perilymph fistula may. When the vestibular is the result of a perilymph fistula, a repair can reduce the severity and frequency of vertiginous episodes. If dysfunction is the result of a breach of the vestibular nerve or the vestibular labyrinth, a few interventions can improve the condition. Symptoms may subside when benzodiazepines are used. A sustainable improvement can occur in the course of vestibular rehabilitation. Patients with temporal bone fracture and Liquorotorrhö should be hospitalized because of the meningitis risk. The CSF leak usually closes spontaneously within a few days, although occasionally a lumbar drainage or surgical defect closure are necessary. The ear canal is not rinsed or manipulated. Prophylactic administration of antibiotics is viewed differently in some centers. Summary An temporal bone fracture can cause blood from the ear, blood behind the eardrum, hearing loss, vestibular dysfunction, and / or a facial paralysis. A CT with emphasis on the skull leg should be made. Patients should receive an audiometry and when a facial nerve paralysis is suspected, an electrical test of the facial nerve appears. A direct treatment of the Fazialisnerverletzung, the hearing loss, the vestibular and spinal fluid leak are urgent.