Diseases Of The Nose Throat And Ear

THE LABYRINTH AND THE EIGHTH NERVE 385

In all cases of suspected fracture a thorough examination of the ear, nose
and throat should be carried out. Radiographic examination of the temporal
bones should be undertaken in the hope of demonstrating the position and
extent of the fracture (Fig. 200). Failure to do so, however, does not exclude
its presence. Repeated examinations employing different positions will
increase the frequency of positive findings. Tomography is often required to

Fig, 201. Fracture of cranial base injury to labyrinth capsule. Horizontal section through right ear. 1,
Malleus; 2, Incus surrounded by blood clot; 3, Facial nerve; 4, The two ends of the posterior vertical
canal; 5, Haemorrhage in branch of vestibular nerve to ampulla of posterior canal; 6, Haemorrhage in
fundus of internal meatus; 7, Haemorrhage in Eustachian tube. ( x 3.)

demonstrate the fracture. Giddiness and tinnitus may accompany the deaf-
ness, but the giddiness usually disappears after a time. While bleeding from
the external meatus is frequently met with, in rare cases the drumhead
remains intact and presents a blue-black appearance (haematotympanum).
If blood alone is present in the meatus, the prognosis from the otological
point of view is better, because it is probable that only the walls of the
middle ear have been involved {Fig. 201). If, however, both blood and cerebro-
spinal fluid flow from the ear, the labyrinth capsule or dura mater or both
have been injured (Fig. 202), and, if due to the former, permanent deafness
will result if the patient recovers. In many cases infection is superadded to
the injury—either from the nasopharynx through the auditory (Eustachian)
tube or from the external meatus—with the result that purulent leptomenin-
gitis may supervene (Fig. 203). Patients who have recovered from fracture
of the temporal bone are predisposed, if they get an acute otitis media, to
suffer from meningitis, the infection in these cases passing to the meninges
along the line of the old fracture.

TREATMENT. The general treatment of fracture of the base of the skull
need not be discussed here. If there is no bleeding from the ear the meatus,
if healthy, should be left severely alone. At a later stage surgical exploration
of the middle ear may be indicated and if dislocation of an ossicle is con-
firmed re-establishment of the ossicular chain may be effected. If haemor-
rhage is profuse the meatus should be carefully cleansed and a strip of

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