386 THE EAR sterile ribbon gauze inserted. Antibiotics should be given in full doses. The meatus should not be syringed. If middle ear suppuration had been present previously, and if cerebrospinal fluid is noted along with blood in the meatal discharge following a fracture of the base, it may be considered advisable Fig. 202. Fracture of cranial base with injury to labyrinth capsule. Horizontal section through right ear just above round window. 1, Fracture of promontory; 2, Both peri- and endolymph spaces of posterior canal contain blood; 3, Vestibule with slight haemorrhage; 4, Line of fracture reaches the canal from nerve to ampulla of posterior semicircular canal; 5, Basal coil of cochlea with haemorrhage in all three scalae. ( x 5.) Fig. 203. Male, aged 44, fell striking the right side of his head. Concussion and bleeding from right ear and also from mouth. Severe headache and feeling of rotation about a vertical axis. Right ear quite deaf. Nausea but no vomiting. Spontaneous nystagmus to left (sound) side. Patient fell to right and showed a pointing error to right. Temperature 105°. Pulse only 72. Kernig's sign present. Facial paralysis (right). Post mortem—Purulent leptomeningitis at base of brain. 1, Fracture; 2, Exudate in vestibule; 3, Fracture of bony spiral lamina; 4, Scala tympani; 5, Fracture of tympanic floor; 6, Exudate in tympanum; 7, Perforation in drumhead; 8, Fracture of meatal wall. to facilitate free drainage, even to the extent of performing the radical mastoid operation with exposure of the dura mater along the line of fracture. 'Explosion' Deafness, Both cochlear and vestibular organs may be damaged by explosion or gun fire but the vulnerability of the cochlea is much greater.