Resident Manual of Trauma to the Face, Head and Neck

II. Indications of Temporal Bone Injury In general, the subjective symptoms and objectives signs of temporal bone injuries will reflect the specific structures that are injured. A. Subjective Symptoms y y Hearing loss. y y Vertigo/imbalance. y y Tinnitus. y y Autophony (hearing oneself speak, or other internal noises, more prominently). y y Aural fullness/pressure. y y Facial weakness. Hearing loss is one of the most common findings associated with temporal bone fractures. Hearing loss can result from damage to the inner ear or middle ear, or a combination may be categorized as sensorineural hearing loss (SNHL), a conductive hearing loss (CHL), or a mixed loss, depending on the location of the fracture as well as the intensity of the impact. Most fractures lead to a CHL, resulting from injury of the TM, ossicular subluxation or discontinuity, hemotympa- num, or any combination of these. Hearing loss can be evaluated at the bedside with a tuning fork, which is described in section IV.C of this chapter. 2. Hemotympanum Injury to the temporal bone and mucosa of the middle ear and mastoid frequently leads to accumulation of visible blood or serosanguinous fluid in the middle ear space. The volume of blood or fluid in the middle ear reflects the extent of the injury and function of the Eustachian tube. If the injury is severe enough or drainage through the Eustachian tube is impaired, the entire middle ear may be filled with blood, resulting in dark discoloration of the TM. 3. Otorrhea When a TM perforation is present, fluid that accumulates in the middle ear space may pass through the perforation and manifest as otorrhea. The fluid may be hemorrhage, exudates from trauma, CSF fluid from a leak, or a combination of all of these. CSF may drain down the y y Drainage from ear. B. Objective Signs 1. Hearing Loss

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