Trauma to the outer ear (auricle) usually is managed by a cosmetic surgeon. Trauma to the temporal bone (ear canal, eardrum, hearing bones and deeper structures) is evaluated and managed by an otologist when other injuries to brain, neck and eye are stable. The four main complications of temporal bone trauma are hearing loss, dizziness, facial muscle paralysis and brain-spinal fluid leakage.
Trauma to the Ossicles
This color photograph by Eiji Yanagisawa, MD is reproduced with permission from Hughes GB and Pensak ML: Clinical Otology 3rd Edition, Thieme Medical Publishers, New York, 2006 (in press).
Trauma has separated two of the ossicles (hearing bones).
Hearing loss can result from tears in the eardrum and dislocation of the hearing bones.
In the figure, the incus and stapes have been separated by trauma. If healing does not occur spontaneously, surgery can repair the eardrum and/or hearing bones to restore significant hearing in most patients. These procedures are discussed under Hearing Impairment and Infection.
Dizziness can result from trauma to the inner ear balance organ as well as the brain. If dizziness does not resolve spontaneously, special testing can identify the origin of symptoms. Surgery and vestibular rehabilitation exercises usually can control inner ear dizziness. Vestibular nerve section is performed if hearing is good (see below) and labyrinthectomy (removal of balance organ) is performed if hearing is poor.
Facial paralysis results from trauma to the facial nerve within its bony canal. Special tests can determine the prognosis for recovery. If spontaneous recovery is not expected, surgical decompression and repair of the nerve can help. Surgery is performed above the ear along the base of skull if hearing is good or is performed behind the ear if hearing is poor.
Cerebrospinal fluid (CSF) can drain from the ear canal or the nostril after temporal bone trauma. Drainage usually stops spontaneously with bed rest in the hospital. If it persists, surgical repair is performed usually through an incision behind the ear with abdominal fat packing to the mastoid and muscle packing to the Eustachian tube.
Middle Cranial Fossa Approach to Facial Nerve
This figure is reproduced with permission from Hughes GB and Pensak ML: Clinical Otology 3rd Edition, Thieme Medical Publishers, New York, 2006 (in press).
The surgeon sits at the top of the patient's head to expose and decompress the facial nerve.