The temporal bone (the skull bone containing part of the ear canal, the middle ear, and the inner ear) can be fractured, usually by a blow to the head.
Temporal bone fractures can cause various injuries to the inner ear structures. Injuries include rupture of the eardrum and damage to the ossicles (the chain of small bones that connects the eardrum to the inner ear), the cochlea (the organ of hearing), the vestibular apparatus (the organ of balance in the inner ear), or the nerve that controls muscles of the face (facial nerve).
People have pain and often bleeding from the ear, blood behind the eardrum, or bruising of the skin behind the ear. Other symptoms and complications vary depending on the exact location of the fracture.
Some people have facial paralysis on the side of the fracture. Facial paralysis can develop immediately or after some time and can be mild or severe.
Another symptom is severe hearing loss. Hearing loss may result from damage to the three tiny bones (called the ossicles) that connect the eardrum to the inner ear or from damage to the cochlea or the nerve that leads to the cochlea.
If the vestibular apparatus is damaged, people may feel as if they or their surroundings are spinning (vertigo) or have problems with balance.
Sometimes, fluid from around the brain and spinal cord (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 possibly serious infection from bacteria in the ear canal.
Diagnosis is made with CT.
Doctors also may test the person's hearing and whether the face is paralyzed. If problems are found, further testing is usually done, such as detailed hearing testing by an audiologist or electrodiagnostic testing (see see Electromyography and Nerve Conduction Studies) of the nerve responsible for controlling facial movement.
Treatment is necessary only if the fracture causes problems.
If facial paralysis is immediate and severe, surgery may be needed. If paralysis is mild or delayed, a corticosteroid drug given by mouth is typically prescribed.
If hearing loss stems from damage to the ossicles, the ossicles are repaired surgically. Hearing loss that results from damage to the cochlea or its nerve is usually permanent.
If vertigo is caused by damage that cannot be repaired surgically, a benzodiazepine drug may provide some relief. People can sometimes learn to compensate for problems that vertigo causes (such as loss of balance) through a series of exercises called vestibular rehabilitation.
People with leakage of cerebrospinal fluid should be hospitalized. If the leak does not stop on its own within a few days, surgery or insertion of a drain near the spinal cord in the lower back (lumbar drain) may be needed to prevent infection.
Last full review/revision March 2013 by Sam P. Most, MD