An adult sustains severe closed head injury in a road traffic accident. On examination there is immediate total hearing loss in the right ear with violent vertigo and nystagmus, though the tympanic membrane is intact. Which finding pattern favours a transverse fracture of the temporal bone over a longitudinal one?

• A Conductive hearing loss from ossicular chain disruption
• B Blood in the external canal with an intact tympanic membrane and normal hearing
• C Delayed facial palsy appearing several days after the injury
• D Immediate profound sensorineural hearing loss with acute vestibular paresis ✓

Explanation

Transverse fractures run perpendicular to the long axis of the petrous pyramid and traverse the labyrinth, destroying the cochlea and vestibular organs, hence a dead ear and acute vestibular failure immediately after injury. Longitudinal fractures, the more common type, run parallel to the petrous axis and usually spare the inner ear, producing conductive loss through ossicular disruption and haemotympanum. Delayed traumatic facial palsy more often accompanies longitudinal fractures.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.