Emergent Care / Stabilization:
The initial assessment of any trauma patient should focus on rapid identification and stabilization of life-threatening injuries or complications. Airway protection may be required for patients with temporal bone fractures resulting from head trauma. Skull fracture wounds can often present with profuse bleeding and require wound closure (direct pressure, hemostatic agents, Raney scalp clips, or sutures) and spine stabilization. When examining potential skull fracture sites, scalp wounds should NOT be probed. (See Best Tests, Management, and Therapy sections for further details.)

Diagnosis Overview:
Head trauma can involve fracture and hemorrhage within the temporal bone and impairment of its contents, which include the middle and inner ear (in the petrous portion of the temporal bone), seventh and eighth cranial nerves, the carotid artery, and the internal jugular vein. This condition is most often reported as the result of motor vehicle accidents, falls, or acts of violence.

Due to the relative weakness of the temporal bone and proximity of the middle meningeal vasculature, temporal bone fractures have increased risk of extra-axial hematoma (bleeding within the skull, but outside the brain parenchyma). Patients on anticoagulants are at even greater risk for intracranial hemorrhage. Such risk may be greatest among elderly patients.

The temporal bone fracture may be a longitudinal, transverse, or mixed-type injury. Frequently, a longitudinal fracture may present with ear injuries, mastoid ecchymosis (Battle sign) or periorbital ecchymosis (raccoon eyes), tympanic membrane laceration, bleeding in the ear canal, hemotympanum, and hearing loss (usually conductive or mixed). Transverse fractures may be associated with facial nerve injury and sometimes hearing loss (usually sensorineural) and vestibular dysfunction.

Newer classifications more predictive of outcome specify otic capsule violating versus otic capsule sparing, as such classification correlates well with risk of concomitant functional complications. Otolaryngologic evaluation is a priority for otic capsule violating fractures as they are associated with higher risks of cerebrospinal fluid (CSF) leak, sensorineural hearing loss, and facial nerve paralysis. Abnormal findings of air in the labyrinth (pneumolabyrinth) and cochlea (pneumocochlea) may also be found in cases of otic capsule violating temporal bone fractures.

Other signs and symptoms include facial numbness, tinnitus, otorrhea (blood or CSF), nausea, dizziness, vomiting, nystagmus, and vertigo. Other complications, such as ossicular fixation and temporary or permanent and complete sensorineural hearing loss, may present months after the initial trauma. Some symptoms may resolve spontaneously or require conservative management. Others may require myringoplasty, tympanoplasty, chain reconstruction of the ossicles, or facial nerve decompression / repair.