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\s=b\Of 1,300 consecutive head-injured patients admitted to the hospital over a 20-month time period, 118 were found to have skull fractures, of which 22% involved the temporal bone. These figures form part of a larger study of 90 temporal bone fractures treated over a six-year period from 1975 through 1981. The most common cause of a temporal bone fracture was a motor vehicle accident occurring in 40/90 (44%) patients. Pertinent physical findings, occurring alone or in combination, were a hemotympanum, bleeding from the ear canal, tympanic membrane perforation, facial paralysis, and CSF otorrhea. The diagnosis of temporal bone fractures is best made clinically and radiographically. The early care of temporal bone fractures is directed toward the treatment of CSF otorrhea and immediate onset facial paralysis. The delayed care is primarily concerned with hearing rehabilitation. (Arch Otolaryngol 1983;109:285-288)

Thus, a presurgical rating of 8 points translates into an 80% chance of restoring hearing to normal or near-normal levels.

The 94 operations analyzed were performed on 80 ears in 73 patients with congenital malformation of the ear. Operative findings included 13 patients with a congenital absence of the oval window, 5 patients with vascular anomaly of the middle ear, and 6 patients with congenital cholesteatoma. Six of 13 patients with congenital absence of the oval window had a labyrinthotomy performed to create a new opening into the vestibule. The method of surgical repair in atresia was a canalplasty with fascia graft overlay for the substitute tympanic membrane. A Silastic button was placed over the substitute tympanic membrane to lessen blunting and to anchor the center-hole skin graft in place. A modified face lift procedure was done if necessary to align the enternal ear with the new ear canal. At present no ear canals are stenosed and no ears are actively discharging. One patient sustained a temporary facial paralysis. The hearing results are discussed.