Expert: Harriet B Jacobster, Au.D. - 8/30/2008

Question
On July 24, Jacob, my 9 year old son, fell backwards 9' from a hay mow and landed on the back of his head, hitting cement. He fractured his temporal bone and his jaw in front of his ear. We don't believe he lost consciousness. He did lose a lot of blood from his left ear. There was a small puddle of blood and two blood-soaked towels.

This happened while Jacob was visiting relatives in Wisconsin. We are from Virginia. My wife and I flew to Wisconsin and spent 6 days with him in the hospital. He received vestibular therapy which corrected his balance in a few days.

We have located a Neuro-otologist in Virginia who is treating Jacob's ear. We have had two appointments with the Neuro-otologist. He did not do anything other than look in the ear during the first appointment which was about two weeks after the injury. Jacob's eardrum was completely ruptured after the fall. During the appointment we told the Dr. in Virginia that the doctors in Lacrosse, WI said that the blood was coming from the fracture. They also said that spinal fluid was leaking from the ear. The Dr. in Virginia rolled his eyes and said the blood was coming from the middle ear.

Last week we had the second appointment. The Neuro-otologist removed a large piece of dried blood from Jacob's ear. All this time Jacob has been telling us that he hears a little bit from the ear. In the hospital Jacob told the Dr. that he hears noise when they ran their fingers along his ear. I'm not sure Jacob was telling the truth. Today Jacob and I were in a music store where they had headsets. I tried them on and they were playing fairly loud music. I thought that would be a good test for his ear. I was stunned when he told me that he could not hear anything. He seemed totally deaf in his left ear. We have a hearing test scheduled for September 5th and another appointment with the Neorotologist after the test. Are we late getting the hearing test?  Should we be doing anything more than we have done so far with Jacob. Do you agree with what our Neuro-otologist has done so far?

Can you shed any light on what you think the problem is and advise if the hearing may return without intervention.

Thank you so much for taking the time to read this.

Todd  

Answer
Hi Todd,
Sorry to hear of your son's trouble. The temporal bone is one of the most complex bones in the body.  Fractures of the temporal bone take one of several forms: longitudinal, transverse, and oblique.  Depending on which type of fracture your son suffered, the damages and the outcomes are different for each.  The most common is the longitudinal in which the hearing loss is usually conductive in nature.  Less common is the transverse which usually results from a blow to the occipital - or back - of the head.  In this case, the loss is usually sensorineural and profound. An oblique fracture is a combination of these two.  If the inner ear was destroyed in the fracture, there probably wasn't much that was able to be done.  Right after the injury, it may have been difficult to assess your son's hearing for many reasons, one of which is the presence of the blood in the middle ear cavity.  I cannot agree or disagree with the Neuro-otologist, but this is his area of expertise.  I am also sure that he had the radiographic reports so he was able to make judgements on your son's condition. I would advise you to go ahead with the audiology testing as ordered by the Neuro-otologist and from there, depending one the results you can make decisions regarding treatment.  I am providing you with a good article which would give you good insight into the condition:  http://www.emedicine.com/ent/TOPIC477.HTM  If you have any questions, or feel uncomfortable with you Neuro-otologist, you should definitely seek a second opinion.
Hope this helps.
Harriet Jacobster, AuD
Board Certified in Audiology