Temporal Bone Fracture with Inner Ear Injury

Critical Initial Assessment

The American College of Emergency Physicians recommends immediate CT imaging of the maxillofacial region and temporal bones in patients with loss of consciousness and mechanism of injury, with a reported 18.9% rate of requiring emergency operative intervention 1
CT maxillofacial is the preferred initial imaging modality for suspected midface injuries, providing high-resolution delineation of osseous and soft-tissue structures, according to the American College of Radiology 3

The American Academy of Otolaryngology suggests that blunt force to the zygomatic arch can transmit forces to the temporal bone, particularly given the anatomical proximity, increasing the risk of temporal bone fracture 3
Zygoma fractures are the second most common isolated facial fracture, and associated orbital floor fractures may cause diplopia, enophthalmos, or oculocardiac reflex, as reported by the American Society of Plastic Surgeons 2

The American Heart Association recommends monitoring for bradycardia or heart block (oculocardiac reflex from potential orbital muscle entrapment), which is a potentially life-threatening condition requiring urgent intervention 2
Complete GCS scoring is recommended by the American College of Emergency Physicians, with a reported 3-13% risk of acute intracranial lesion in patients with GCS 14 or less, or GCS 15 with LOC 1, 4

Up to 28% of mild TBI patients develop postconcussive symptoms lasting beyond 6 months, including chronic headaches, dizziness, balance problems, and vision problems, according to the American Academy of Neurology 5
Patients should receive written discharge instructions at sixth-grade reading level, and follow-up with TBI specialist if symptoms persist beyond 3 weeks, as recommended by the Centers for Disease Control and Prevention 5