home Endocrinology Signs of a temporal bone fracture. Temporal bone fracture: symptoms, treatment, consequences. Where is TBI treated?

Signs of a temporal bone fracture. Temporal bone fracture: symptoms, treatment, consequences. Where is TBI treated?

Temporal bone- this is one of the bones that makes up the base of the skull, covers the temporal(lateral) brain area. It is a steam room: there are left and right parts. Fractures of the bones of the base of the skull occur in 4% of all cases, of which 75% are fractures of the temporal bone specifically.

Photo 1. Head injuries are among the most dangerous due to the possibility of brain damage. Source: Flickr (Dion Hinchcliffe)

Structure of the temporal bone

The temporal bone is formed as a result of the fusion of 3 bones: the squamosal, the tympanic and the pyramidal (petrous), the fusion sites are marked by grooves. Complete fusion of the bones occurs by the end of the first year of life and closes the external auditory canal.

The temporal bone has several processes that are involved in the formation of the auditory canal, jaw joint, and muscle-ligamentous apparatus. The bone is also penetrated by 9 channels through which nerves (facial, vagus, trigeminal) and blood vessels (tympanic vessel, aqueductal vein, internal carotid artery) pass.

Note! Injuries to the temporal bone are very dangerous for human health and life, as they can lead to neurological disorders of varying severity, complications such as meningitis, hearing loss, and severe hemorrhage when the carotid artery ruptures.

Causes of fractures

A temporal bone fracture occurs due to a blow from a hard object to the temporal region of the skull(a strong blow to the temple in a fight, hitting the corner of furniture when falling, etc.). This bone is quite thin, so local pressure on it very often results in a fracture.

Temporal bone fractures in children

In children under one year of age, the fusion of the components of the temporal bone is not yet complete; in the preschool years articulations still pretty weak. For this reason, and also due to increased physical activity in children, temple fractures are quite common.

It is important! It is worth considering that a child’s bone density is quite low, and the nervous system is still imperfect, so head injuries can have the most severe consequences.

Types of temporal bone fractures

Depending on the location of the blow, the fracture can occur in any part of the temporal bone: tympanic, squamosal, pyramidal, various processes, and sutures may split.

Fractures of the tympanic labyrinth

With such fractures there is opening of the tympanic cavity, which is accompanied by bleeding from the ear (sometimes it is not blood that is released, but cerebrospinal fluid). In some situations, blood cannot leave the ear and a bruise forms behind the auricle (Battle's sign).

Temporal bone squamous fracture

This type of fracture is one of the most common injuries although in this case displacement of fragments is often observed. Usually the injury is accompanied by hearing impairment. Externally it may manifest itself as bleeding from the ear or nose; periorbital ecchymosis is rarely seen.

Fractures of the pyramidal bone

The most difficult from the point of view of treatment and prognosis are fractures of the pyramidal bone. With such injuries, patients often lose consciousness (for up to several days) and may even fall into a coma.

Fractures of the pyramidal portion of the temporal bone are one of the most common causes of mortality in traumatic brain injuries. There are 3 types of fractures:

Transverse. With such an injury, the patient loses consciousness (the duration of unconsciousness depends on the severity of the injury), possible hemorrhage from the nose and ears, Battle's symptom, periocular ecchymosis, horizontal nystagmus, effusion of cerebrospinal fluid. Complications include hearing impairment (rarely vision), paralysis of the facial nerves, loss of vestibular function, neurological autonomic disorders and other symptoms of TBI. Depending on the severity of the injury, the consequences can be either reversible or irreversible. In especially severe cases, a vegetative state and even death may develop.
Longitudinal. Such a fracture can develop due to a blow to the parieto-occipital region. This injury usually does not affect the labyrinths of the capsule, but can seriously damage the facial nerves and blood vessels. For this reason, the symptoms of a longitudinal fracture of the temporal bone are very pronounced: rupture of the eardrum or hemorrhage into it, leakage of blood or cerebrospinal fluid from the ear, loss of consciousness, nausea and vomiting, paresis of the facial nerves, and so on.
Atypical. This injury involves the smallest and thinnest areas of the temporal bone, including the capsules of the labyrinth. The patient exhibits hearing loss, however, maintains a sense of balance. Dizziness is also observed with sudden movements of the head. Bleeding from the ears is extremely rare.

Signs of a temporal bone fracture

Depending on the location of the injury and its severity, the symptoms will differ slightly. However, there are a number of indicative symptoms that may indicate a temporal bone fracture:

gaping wound at the site of injury (),
damage to the soft tissues of the temporal region of the skull without compromising the integrity of the bone,
dizziness and nausea of the victim,
loss of consciousness, coma,
paresis and paralysis of the facial nerves,
hearing impairment or loss,
bleeding from the ear,
Battle's sign,
leakage of brain fluid from the ears or nose,
nose bleed,
horizontal nystagmus,
visual impairment,
periocular ecchymosis (bruising around the eyes),
may happen seizure.

If the above symptoms appear, the victim must be transported to the emergency room or neurological department. If a person is unconscious, you must call an ambulance.

First aid for a temporal bone fracture

For a closed temporal lobe fracture, it is necessary provide the victim with maximum peace of mind and, if possible, deliver his to a medical institution. You can apply a cool, damp towel to your head.

It is important! In case of a temporal bone injury, do not warm up your ear or put anything in it!

In the case of an open fracture, you should not wash the wound, as this action can contribute to infection and subsequent complications. If possible, you can impose on the wound and take the victim to the hospital. If the patient is unconscious, you need to call an ambulance to transport him.

Diagnosis of a fracture

In terms of external symptoms, a fracture of the temporal bone is similar to a concussion. A distinctive feature is bleeding from the ear. However, injuries to other bones that make up the base of the skull have similar symptoms. To do this, it is necessary to carry out differential diagnosis.

The most informative method for diagnosing bone fractures is radiography. Due to the structural features of the temporal bone, for an accurate diagnosis it is necessary to perform fluoroscopy in 3-4 projections. It is also possible to conduct an MRI, and laboratory tests of blood and leaking cerebrospinal fluid are prescribed.

Treatment of a temporal bone fracture

In most cases, with this injury, it is indicated conservative treatment. Surgery is performed only in cases of open or displaced fractures. You may also need mastoidotomy(dissection of the mastoid process) and eardrum drainage.

Conservative treatment mainly consists of anti-infective therapy, since in other cases (for example, bone fusion) recovery occurs spontaneously.

It is important! A fracture of the temporal bone extremely rarely consists of a fracture itself. In many cases, there is a concussion or contusion of the brain, and sometimes damage to the brain matter. Therefore, this injury often requires treatment from a neurological point of view.

Without proper neurological care, the patient faces numerous complications that can significantly reduce his quality of life.

Complications of temporal bone injury

The consequences of a fracture for a person depend on several factors: the location of the injury, the degree of its severity, the general health of the person and his medical history, the timeliness of first aid, the correct choice and responsible treatment. The most common consequences, which can be either reversible or irreversible:

spontaneous recovery with minimal residual effects (occasional headaches, slight hearing loss);
decreased or loss of hearing;
chronic otitis;
facial nerve damage: disturbance of innervation of facial muscles, paresis and paralysis, pain syndrome;
visual impairment;
purulent meningitis (the danger of its development persists throughout life);
neurological disorders, characteristic of TBI: ataxia and impaired coordination of movements, headaches, speech apraxia, memory loss and other mental disorders.

Rehabilitation after a temporal bone fracture

Typically, for bone fractures, procedures during the rehabilitation period are aimed at restoring the motor function of the injured limb, but the consequences of a temporal bone injury are more similar to a TBI and are more neurological in nature. Rehabilitation of a temporal bone fracture consists of:

(drugs that improve oxygen supply to tissues, vitamins, neuroprotectors, diuretics, sedatives, antibiotics in case of infection);
massage of the head and collar area;
Exercise therapy for disorders of the body’s motor functions;
working with a speech therapist for hearing and speech disorders.

The rehabilitation period takes from 4 weeks to 6 months from the moment of injury. Over the next 1.5-2 years There is still an opportunity to correct some residual effects. After this period, we can talk about established changes.

Prevention of fractures

Photo 2. Simple precautions will help avoid serious consequences.

A temporal bone fracture is a common companion to traumatic brain injuries. Dangerous to life and health. The most severe consequences include unilateral hearing loss, a lifelong risk of meningitis, poor coordination and other neurological impairment.

Types of injury and characteristic symptoms

In the temporal bones there are canals through which the facial, vagus and other nerves, the carotid artery and other vessels that supply the auditory and vestibular apparatus pass. Symptoms will vary depending on the direction of the blow and what part of the bone is damaged, as well as the location and size of the hemorrhages.

When struck in the area of the crown or back of the head, a longitudinal fracture often occurs. Typical symptoms:

bleeding from the ear;
hearing impairment (due to swelling of the eardrum);
possible leakage of brain fluid from the ear (it is colorless and odorless);
possible development of facial edema.

Impacts to the temple and back of the head lead to transverse fractures. Typical symptoms:

loss of consciousness for a period of 2 hours to several days;
paralysis of the facial nerve (manifests itself even in an unconscious state: the folds on the forehead and nose are smoothed out, the corners of the mouth are lowered);
visual disturbances and involuntary eye movements;
severe dizziness, nausea and vomiting;
vestibular disorders.

Based on the degree of bone damage, the following types of fractures are distinguished:

A linear fracture is a crack in the bone. Accompanied by minimal displacement of bone fragments, often has a large length.
A depressed fracture is diagnosed when the broken fragment is displaced into the cranial cavity. Occurs when hitting an object with a flat surface and a relatively small size (up to 3 cm in diameter). With severe damage, a through hole is formed in the bone.
A comminuted fracture is accompanied by the formation of fragments. The damaged fragment remains connected to the adjacent bones, i.e., no through hole is formed.

Accurate diagnosis is only possible after an X-ray or CT scan.

Temple fractures are always traumatic. Possible reasons:

blow to the head with a heavy weapon (stone, club);
falling on a hard and sharp object (less often);
hit to the head in an accident, fall from a height, sports injury, etc.

Damage to the temporal bone is never asymptomatic, i.e. it is impossible to miss them. However, minor injuries to the temple may be accompanied by fractures of adjacent bones of the skull (parietal, vault), temporomandibular joint and lower jaw, bruises and hemorrhages. Therefore, even if there are no symptoms mentioned above, if you have a head injury, you should immediately consult a doctor.

First aid

The victim must be provided with medical assistance as quickly as possible:

Call an ambulance.
Prevent infection: If there is bleeding from the ear or nose, apply a sterile bandage. Do not use unsterile or contaminated materials.
Prevent the movement of fragments by ensuring immobility.
Not washing the wound or instilling any medications is a direct path to the development of complications.
Do everything possible to ensure that the victim is taken to the hospital as soon as possible: meet the ambulance, briefly describe the situation, help with loading into the car.

In the hospital, the victim will be given an X-ray, and, if necessary, a CT scan and histological analysis, the location and severity of the injury will be clarified, and, after stabilization of the condition and emergency care, further treatment will be prescribed.

Therapeutic measures

Depressed and comminuted fractures require surgery. Linear can be treated conservatively. A course of antibiotics is prescribed to prevent infection.

Neurosurgeons treat skull injuries. To correct impairments of coordination, vision and hearing, neurologists, ophthalmologists, and otolaryngologists are involved. If the temporal lobe of the brain, which is responsible for speech (oral and written) and the perception of auditory information, recognition of emotions and short-term memory, is damaged, long-term rehabilitation may be required with the involvement of speech therapists and other specialists.

Possible consequences

A fracture of the temporal bone pyramid threatens with serious consequences, such as:

complete and irreversible hearing loss;
development of meningitis;
facial nerve paralysis.

The prognosis depends on the severity of the damage and the adequacy of treatment. With timely medical care, it is most often possible to avoid complications, however, for example, if the auditory part (“cochlea”) is destroyed, hearing on the side of the fracture is lost forever.

Also, survivors of a temporal bone injury have an increased risk of developing meningitis, an inflammation of the meninges. This is due to the fact that a defect forms at the fracture site, opening the path of infection through the middle ear. The defect can be compensated by installing a special implant. You should also treat otitis when the first signs appear and under the supervision of a doctor in order to recognize the onset of inflammation in time and prevent complications.

Damage to the temporal bone is often combined with. In this case, problems may arise in the functioning of the chewing apparatus.

The most severe consequences are caused by transverse fractures. They are accompanied (and paralysis of the facial muscles), rupture of the eardrum, destruction of the auditory ossicles and loss of the vestibular apparatus. Lost functions are partially compensated by the work of similar organs on the undamaged side.

Conclusion

The prognosis for temporal bone injury is often favorable. Due to the proximity of other bones and soft tissues, fragments are rarely displaced, and with timely assistance, brain injury and the development of infection can be avoided.

The temporal bone is strong enough to withstand moderate impacts, and it is almost impossible to damage it in everyday life.

If you suspect severe injuries, you should urgently call an ambulance. By following the doctor’s recommendations and completing a rehabilitation course, you can count on a full recovery.

The temporal bone (Latin - os temporale) is a kind of center of the skull. Many cranial nerves and vessels supplying blood to the brain pass through the thickness of the bone or along its edges. The temporal bone itself contains the middle and inner ear with all its structures, as well as the vestibular apparatus, necessary for maintaining the position of the body in space. It consists of both a scaly part, which forms the vault of the skull, and a rocky part, located in the center of the skull.

A temporal bone fracture is a violation of the integrity of bone tissue due to exposure to a traumatic factor. Due to the fairly close contact with the surrounding soft and bone tissues, the fracture is rarely displaced or comminuted. The presence of fragments is most often present in open head injuries.

There are three types of non-displaced fractures:

Longitudinal;
Transverse;
Atypical.

Any injury may be accompanied by concomitant pathology:

Combination of os temporale fracture and concussion;
Hemorrhage into the posterior or middle cranial fossa;
Damage to the eardrum or middle ear structures.

The type of fracture and the complication accompanying it provide a clear clinical picture from which diagnosis and assistance can be made.

Symptoms of a temporal bone fracture

Temporal bone injuries, like all others, are characterized by common symptoms: pain, swelling, bleeding. Blood loss can reach significant volumes due to the fact that the internal carotid artery passes through the temporal bone, and large venous sinuses are adjacent to the brain. Due to their specific structure and location, fractures in the temporal region have a number of characteristic features.

A longitudinal fracture affects not only the temporal, but also the occipital, sphenoid, and frontal bones. It is formed as a result of a blow to the occipital or parietal region. With such an injury, the integrity of the eardrum is often compromised, hearing is affected, and sometimes hemorrhages occur in the posterior and middle cranial fossae, which we will discuss below.

A transverse fracture passes through the entire length of the temporal bone and affects almost all structures located in it. The patient may be unconscious for the first few hours, his hearing may be affected, nausea and vomiting will develop, there may be bleeding from the external auditory canal, severe dizziness, possible double vision, and a feeling that all surrounding objects and the victim’s body are rotating. An extremely important symptom indicating a severe degree of trauma is loss of the functions of the facial and abducens nerves, which will manifest itself as paralysis of the facial muscles on the affected side and the appearance of strabismus.

If transverse and longitudinal fractures occur along the petrous part of the temporal bone, then atypical ones almost always affect the squamosal bone. Here, lesions of the structures of the temporal bone, as well as the vessels and nerves passing through it, are quite rare. However, due to the thinness of the scaly part, perforations with penetration into the cranial cavity and injuries to brain tissue often occur.

Concussion and os temporale injuries almost always occur simultaneously. Unlike other injuries, a fracture of the temporal bone causes a severe concussion, with severe confusion, loss of consciousness for several hours, nausea and vomiting. Violations of oculomotor function, anisocoria (different pupil widths), and speech disorder are not uncommon.

Hemorrhages in the posterior and middle cranial fossae are one of the most severe complications not only of injuries to the temporal region, but of all traumatic brain injuries as such.

Hemorrhage in the posterior cranial fossa may at first be hidden by the unconscious state of the victim. It is characterized by respiratory and cardiac disorders; patients often die without regaining consciousness.
Hemorrhage into the middle cranial fossa causes paralysis of almost all cranial nerves, impaired vision, hearing, nausea, and vomiting. Bleeding from the external auditory canal, nasal cavity, nasopharynx and oropharynx is common.

If the eardrum and structures of the middle ear are damaged, hearing on one side sharply decreases or disappears, severe pain occurs, and bleeding from the external auditory canal occurs.

Remember!
Victims with a temporal bone fracture or suspected fracture should be hospitalized immediately. Delay is fraught not only with hearing loss, but also with death among patients.

First aid and treatment

First aid involves applying a sterile bandage to the head and transporting the patient to the nearest medical facility.

In a hospital setting, surgical treatment is performed only in the presence of an open craniocerebral injury or in the cranial cavity. Primary surgical treatment of the wound, reposition of bone fragments, removal of tissue detritus and foreign bodies are performed. If necessary, open and pump out.

Damage to the structures of the middle ear and eardrum is eliminated after the relief of life-threatening conditions. In the case of a long period without treatment, hearing loss and deterioration is possible.
When there are no indications for surgical intervention, patients are prescribed drug therapy, which consists of:

Combating cerebral edema with osmotic diuretics;
Relief of neurological symptoms, neuroprotection. It is carried out by introducing B vitamins, nootropics, neuroprotectors;
Analgesic therapy using narcotic and non-narcotic painkillers;
Symptomatic elimination of nausea and vomiting with centrally acting antiemetics;
In case of inappropriate or violent behavior on the part of the patient, sedatives are used in the form of benzodiazepine tranquilizers or sleeping pills of the latest generation.

Later, after discharge from the hospital, the patient is registered with a neurologist; symptomatic therapy is carried out in case of chronic headaches, nervous system disorders or damage to the cranial nerves.
If the victim has a pronounced cosmetic defect, then during the first 3-6 months after the injury the highest quality surgical restoration of the correct forms of the temporal region is possible. Delaying plastic correction will lead to the formation of rough scars and bony outgrowths, making subsequent cosmetic interventions difficult.

Prognosis after fracture

An important point in the prognosis of further life activity is the severity of the injury received and the speed of seeking help from a medical institution. Early surgical and therapeutic care can lead to a full recovery. Otherwise, a number of complications are possible:

Death due to hemorrhage into the cranial cavity is observed in 80-95% of cases in the absence of surgical treatment. In case of hemorrhage in the posterior cranial fossa without medical assistance, the mortality rate is 100%;
Formation and preservation of neurological defects in the form of memory, mental, and cognitive disorders. Often, such complications develop after severe injuries or when the patient does not comply with the doctor’s recommendations;
Disorders of the facial and abducens nerves are difficult to prevent and treat. Prevention consists of bed rest in the first days after injury, taking neuroprotectors and B vitamins. Treatment is carried out on an outpatient basis, it is possible to use both medications and physical procedures;
Hearing impairment is one of the most common consequences after a temporal bone fracture. Currently, there are many hearing aids that can restore hearing completely after injuries to the eardrum and auditory ossicles. However, if damage to the inner ear has occurred, hearing loss is permanent in most cases;
Damage to the vestibular apparatus is manifested by nausea, vomiting and dizziness in the first days after the injury. Afterwards, dizziness can be observed when climatic conditions change, during emotional stress, and the development of vegetative-vascular dystonia is possible. Such people should refrain from driving any type of transport in the first 2-3 months after injury and from extreme sports throughout their lives.

Be vigilant and remember that it is easier to avoid any injury than to get rid of it and its consequences!

A fracture of the temporal bone in a child or adult can have serious consequences, since important blood vessels and nerves pass through it. Injuries can lead to loss of balance, hearing, and facial paralysis. Bleeding and pain, and sometimes leakage of brain fluid, accompany injuries.

Structure and functions of the temporal bone

The temporal bone anatomically consists of three parts: squamous, petrous, tympanic, which are separated from each other by slits. The scales have two surfaces: the medulla and the outer. The meningeal nerves pass through it. The tympanum contains the external auditory canal. In the rocky part, the densest part, which forms the base of the skull, is the vestibulocochlear nerve, the organ of hearing and balance.

Learn about the different degrees of severity.

The fracture is accompanied by an increase or decrease in intracranial pressure. When the patient feels nauseated, vomiting occurs. In this case, vomiting does not bring relief, since it is of central origin and occurs due to irritation of sensitive receptors in the hypothalamus. This can also occur with damage to the vagus nerve.

If the patient is unconscious, then vomit can enter the respiratory tract and further cause inflammation in the trachea, bronchi, and lungs.

Damage to brain tissue by bone fragments from a strong blow causes a change in the reaction of one of the pupils to light, which becomes asymmetrical. Damage to the vagus nerve causes disruption of the heart. This nerve inhibits myocardial contraction, and if damaged, tachycardia may occur.

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The trigeminal nerve, the trunk of which passes through the pyramid of the temporal bone, provides sensitive innervation to the face. If damaged, his face may go numb. With a strong blow, the facial nerve, which is responsible for the motor innervation of the face, can rupture. The consequence of this is facial paralysis and asymmetry.

The main formations are the vestibular-cochlear nerve, which transmits signals from the vestibular apparatus, as well as the organ of hearing. When the temporal bone is fractured, the eardrum often ruptures, the consequences of which are serious, as the patient develops lifelong deafness.

Damage to the nerve plexuses of the hearing organ leads to sensorineural hearing loss. Violation of the integrity of the vestibular apparatus leads to loss of balance both at rest and in motion. The patient feels severe dizziness. Microcracks and microfractures of the bony labyrinth of the temporal bone are dangerous.

Diagnosis of a temporal bone fracture

The first examination that needs to be done if a temporal bone fracture is suspected is a computed tomography scan of the brain. X-rays are performed later. An examination by a neurologist is required to possibly detect paresis of the facial muscles.

Performed on patients:

audiometry;

checking the functions of the vestibular apparatus;

tuning fork tests by Rinne and Weber to determine the nature of hearing loss: conductive or sensorineural.

Treatment

First aid is to apply an immobilizing sterile bandage to the head to ensure immobility of bone fragments. To prevent aspiration of vomit into the respiratory tract, it is necessary to place the head on the uninjured side so that the contents of the stomach do not enter the larynx, but are poured out.

It is necessary to urgently take the victim to a medical center for a full examination and treatment. If clear fluid leaks from the ear and nose, infection from the external environment should be avoided.

Important! When providing first aid, rinsing and instillation into the ear should not be done to avoid infection of the central nervous system.

In case of facial paralysis on the side of the fracture, the function of the facial nerve is restored. If it is torn, it is stitched end to end. To reduce the intensity of inflammation of the facial nerve, ear suppositories with hormonal agents are used.

Damage to the eardrum requires surgery to repair. Fracture of the ossicles of the hearing aid (hammer, stapes and incus) also requires surgical intervention.

To prevent infectious complications during liquorrhea, antibacterial drugs are used. In case of suppuration, an audit is performed. In case of cerebral edema, dehydration therapy is performed - the administration of diuretics (Furosemide).

Conclusion

The consequence of a fracture of the temporal bone can be sensorineural and conductive hearing loss, dysfunction of the vestibular apparatus, and impaired facial sensitivity. Some injuries can be treated surgically or go away on their own.

A fracture of the temporal bone, the consequences of which are unpredictable, can radically change a person’s life. Fears about the future state of health will accompany a person for the rest of his life, even with a favorable outcome.

After deformation of the temporal bone, which occurs from a blow to the head, serious consequences are possible. A bone injury is diagnosed with a certain degree of probability by an X-ray examination of the skull. But the peculiarity of a fracture of the temporal part lies in the presence of microscopic damage to bone structures that are not noticeable on an x-ray. These kinds of signs can be revealed by histological analysis when examining the temporal bone. If these research methods are not able to determine the exact clinical picture, computed tomography (CT) will help.

Symptoms and manifestations

Pronounced injuries of this kind cannot be ignored, because they are accompanied by many characteristic symptoms. In the area of the temporal bone is the auditory zone of the cerebral hemispheres. There is a connection with the gravitational apparatus, the external and internal auditory tube, therefore, its damage leads to impaired coordination of movements and hearing acuity.

The most obvious sign is Battle's symptom - ecchymosis in the postauricular area, accompanied by bleeding from the external auditory canal. Bleeding comes from the middle ear cavity through a deformed eardrum or from damaged vessels of the Eustachian tube at the fracture line.

Internal bleeding in the middle ear cavity leads to the formation of hematomas and is manifested by the formation of dark bruises on the skin and the area of the eardrum. In addition to blood, there are frequent cases of cerebrospinal fluid leaking from the ear canal. This proves the relationship between the middle ear cavity and the subarachnoid zone. Fractures can injure this area, leading to rupture of the eardrum.
The mucous membranes lining the ear canal and the tympanic cavity are equipped with sensory nerves and form the tympanic plexus. When the conductive fibers of the nervous tissue are pinched, paresis of the facial nerves, as well as sensorineural hearing loss, are possible in 20% of cases. Complete paralysis of the facial muscles may appear after some time. This symptom indicates that there was no damage to the auditory analyzer.

There are 3 auditory ossicles located in the middle ear cavity. They form a more or less mobile chain from the eardrum to the oval window of the inner ear and are located across the tympanic cavity. Articulating with the help of a movable connection - a joint and several additional ligaments, they provide bone conduction of sound waves and mechanical transmission of sound vibrations. Damage to the contacts at the junction of the incus, malleus and stapes causes conductive hearing loss.

Fractures of the pyramid of the temporal bone

Fractures of the temporal bone pyramid are divided into several types. considered the most dangerous. The injury is accompanied by loss of consciousness for several hours or days. Damage to an area of dense bone structure is caused by direct mechanical force in the occipital or temporal zone and is accompanied by paralysis of the facial and outgoing nerves. Symptoms of paralysis are detected within an hour despite the coma. The cochlear and vestibular functions of the body cease completely or partially. The patient is unable to maintain balance and falls when walking. There is a risk of hematotympanum. In some patients, cerebrospinal fluid (CSF) leaks through the external auditory canal. When cerebrospinal fluid enters the Eustachian tube, which communicates with the nasopharynx, fluid flows out of the nose. These signs are accompanied by rotational dizziness, coupled with nausea and vomiting not caused by food intake. In severe cases, the otolith apparatus and cochlea of the inner ear are destroyed, leading to complete deafness. With partial damage, hearing loss occurs.

Doctors most often deal with longitudinal fractures of the temporal bone. This type of injury is characterized by the absence of displacement of damaged bone fragments. The localization area is the parieto-occipital zone. The tympanic cavity, not reaching the labyrinth, is injured. Blood clots accumulate near the eardrum, which acquires a bluish tint, while maintaining its integrity.
A fracture is called an atypical one because the thinnest plates are damaged and microcracks are formed in the bone capsule of the labyrinth. Some patients develop peripheral paresis of the facial nerve on the injured side. The activity of the vestibular apparatus, as a rule, is not impaired. The consequences are expressed in the appearance of hearing loss and horizontal nystagmus. When turning the head sharply, dizziness intensifies.

First aid for injury

If the temporal bone of the skull is fractured, the victim must be given immediate assistance. To do this, apply a sterile bandage to the area of injury and urgently take the victim to a medical facility. You should not wash a bleeding wound, much less instill any medications, including painkillers. Treatment of the patient most often involves conservative therapy.

It is necessary to bring all vital systems of the body back to normal. Surgical operations are carried out after stabilization of the general condition and elimination of pain. Symptoms of concussion or brain contusions should be excluded.

The acute period is accompanied by preventive measures to prevent swelling of the soft membranes and parts of the brain. There is a high probability of infection of the wound surfaces of fracture lines, which lead to intractable inflammatory processes. To prevent recurrent infectious complications, patients are prescribed a course of antibacterial therapy and dehydration treatment.

If the patient has a history of purulent otitis or the cause is caused by a trauma to the temporal bone, they resort to surgical intervention using the method of extended mastidotomy. The need for this surgical procedure is rather due to preventive purposes, because under the thin connective tissue film covering the infected segment of the middle ear, active proliferation of pathogenic bacteria occurs. Due to the inaccessibility of visual inspection, inflammation can cause purulent meningitis, which lasts silently for several years.

Consequences of injury

A person with a temporal bone fracture is at risk of meningitis throughout his life. With inflammation of the middle ear - otitis media - there is a risk of infection entering the brain. Therefore, after the child is discharged, you should be wary of every painful sensation in the hearing organs. Frequent consultations with an otolaryngologist are necessary. The likelihood of infection is eliminated by means of a special graft that fills the defect in case of injury to the bone plates.

When the membrane ruptures, blood flows out of the external opening of the auditory tube. Subarachnoid hemorrhages are life-threatening. Even with small volumes leaking into the brain structures, the risk of reactive meningitis increases. Affecting the delicate structure of neurons and neuroglia, it is severe and fleeting, often with a fatal outcome.

The inner ear, or labyrinth, is localized in the thickness of the pyramid of the temporal bone. Consists of the vestibule, semicircular tubules and cochlea. If the cochlea is damaged, despite the entire range of rehabilitation measures, hearing cannot be restored. In case of damage to the labyrinth, cases of spontaneous recovery are possible, but complications of the functional activity of the vestibular apparatus are not observed. There is a loss of excitability and conductivity, which leads to deafness and paralysis of the facial muscles.

To avoid complications, at the slightest suspicion of injury in the temporal zone, you should immediately contact a specialist.

If the pyramid of the temporal bone is damaged, the victim may lose not only his hearing, but also his life as a result of severe infectious complications.