The temporal bone (the skull bone containing part of the ear canal, the middle ear, and the inner ear) can be fractured by a blow to the head.
Temporal bone fractures frequently rupture the eardrum and may also damage the ossicles (the chain of small bones that connects the eardrum to the inner ear) and the cochlea (the organ of hearing).
Symptoms include facial paralysis on the side of the fracture and profound hearing loss, which may be conductive, sensorineural, or both (see Hearing Loss and Deafness: Causes). People may have bleeding from the ear, blood behind the eardrum, or patchy bruising of the skin behind the ear. Sometimes, cerebrospinal fluid leaks from the brain through the fracture and appears as clear fluid draining from the ear or nose. Leakage of this fluid indicates that the brain is exposed to infection.
Diagnosis is made with computed tomography (CT). Treatment usually requires an antibiotic given intravenously to prevent infection of the tissues covering the brain (meningitis). Sometimes, persistent facial paralysis caused by pressure on the facial nerve can be relieved by surgery. Damage to the eardrum and structures of the middle ear is repaired surgically weeks or months later if necessary.
Last full review/revision February 2008 by Richard T. Miyamoto, MD