injuries poisoning
Temporal Bone Fractures
Treatment of Temporal Bone Fractures
Management of facial nerve injury, hearing loss, vestibular dysfunction, and cerebrospinal fluid (CSF) leakage Treatment is based on managing facial nerve injury, hearing loss, vestibular dysfunction, and CSF leakage. If immediate facial nerve paralysis occurs with loss of electrical response, surgical exploration may be warranted. Delayed-onset or incomplete facial paralysis almost always resolves with conservative management, including use of corticosteroids, which are gradually tapered. Conductive hearing loss requires ossicular chain reconstruction several weeks to months after the injury. Good results can be expected. When sensorineural hearing loss occurs, it is typically permanent, and there are no medical or surgical therapies available to improve hearing. However, in the rare case of fluctuating sensorineural hearing loss, an exploratory tympanotomy to search for a perilymph fistula may be indicated. When vestibular dysfunction results from perilymph fistula, repair may reduce severity and frequency of vertiginous episodes. When dysfunction results from injury to the vestibular nerve or vestibular labyrinth, few interventions can improve outcome. Symptoms may subside when benzodiazepines are used. More lasting improvement may occur with vestibular rehabilitation. Patients who have a temporal bone fracture and CSF otorrhea should be hospitalized because meningitis is a risk. The leak usually stops spontaneously within a few days, although a lumbar drain or surgical closure of the defect is occasionally required. The ear canal is not irrigated or manipulated. Prophylactic antibiotics are used in some institutions. 