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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.
y
y
Drainage from ear.
B. Objective Signs
1. Hearing Loss
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