Early ENT involvement can improve long-term quality of life after temporal bone fractures
Reviewed by Rohit Verma

Sports injuries and road traffic accidents are common causes of head injuries, with 18-40% of skull base fractures involving the temporal bone. Often these patients have other more life threatening injuries so ENT intervention is delayed or absent. Facial palsy, deafness, imbalance, tinnitus and CSF leak are common sequelae and all can affect quality of life. This study looks at management of 39 cases involving 45 temporal bone fractures over an 11-month period. All patients presenting with immediate and total facial nerve palsy were managed with surgical exploration and decompression after imaging and EMG (mean 15 days). Vestibular symptoms were managed with high dose corticosteroids and vestibular rehab. SNHL and tinnitus were managed with high dose corticosteroids. Patients were followed up over 12 months. At initial assessment after injury, 28% patients had immediate facial palsy (HBIII-VI), 50% reported vestibular dysfunction and 85% had hearing dysfunction or impairment. Twenty-seven patients were reviewed after 12 months. Forty-four percent suffered with balance problems with 33% reporting it as disabling. Fifty-six percent had reduced hearing with 44% reporting disabling levels. Tinnitus was also reported in 56% with 44% reporting it as disabling. Fifteen percent had facial palsy after 12 months. Relationships were identified between the presence of initial facial palsy (>HBII) and long-term severe balance problems. Initial vestibular deficit was associated with long-term hypoacusis. This paper highlights the effects on quality of life of temporal bone fractures. Cochleo-vestibular sequelae can be disabling indicating the need for ongoing follow up with an ENT team as well as early involvement at the time of injury. The authors acknowledge that it is difficult to separate sequelae of cranial trauma from the symptom profile of temporal bone fractures. 

Temporal bone fractures: sequelae and their impact on quality of life.
Montava M, Mancini J, Masson C, Collin M, Chaumoitre K, Lavieille J-P.
AMERICAN JOURNAL OF OTOLARYNGOLOGY
2015;36(3):364-70.