A 20-year-old man sustains a temporal bone fracture after a road traffic accident. On examination, he has ecchymosis over the mastoid process, hemotympanum, and clear fluid draining from the ear. Which sign is he exhibiting, and what is the initial management of the otorrhea?
- A Battle's sign; allow free drainage, do not pack the ear ✓
- B Raccoon eyes; nasal packing to prevent CSF leak
- C Crescent sign; urgent lumbar drain placement
- D Cushing's reflex; immediate craniotomy
Correct answer: A. Battle's sign; allow free drainage, do not pack the ear
Explanation
Ecchymosis over the mastoid process is Battle's sign, indicating basilar skull fracture. CSF otorrhea should be managed conservatively with free drainage. Packing the ear is contraindicated as it can cause retrograde infection or increased intracranial pressure. Most CSF leaks resolve spontaneously within 7-10 days with conservative management.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.