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.