Summary
Trauma priorities: temporal-bone fractures often accompany intracranial, cervical-spine and vascular injury, so resuscitation precedes otological assessment. Record facial movement as early as practicable, before sedation where this does not delay resuscitation.
Classify the fracture as otic-capsule sparing or violating and document facial function, hearing, CSF leak and vascular involvement. Capsule-violating fractures carry a higher risk of SNHL, facial palsy and CSF leak.
Most uncomplicated conductive loss and many facial palsies recover with observation. Immediate complete paralysis, suspected CSF leak or vascular injury, severe bilateral hearing loss and progressive cochleovestibular symptoms need urgent imaging and a decision on facial-nerve exploration, leak repair, vascular control or cochlear implant assessment.