172 Clinical and Experimental Otorhinolaryngology Vol. 1, No. 3: 171-173, September 2008 Fig. 1. (A) Axial CT scan of the temporal bones through the level of the otic capsules (bone window). Note the presence of bilateral transverse temporal bone fractures through the otic capsules (see black arrows). The temporal bone fractures appear to involve the otic capsule near the round window niches of the jugular bulb on the right side and through the cochlear axis on the left side. The left fracture line creates a bony separation shaped triangular particle posterior to the cochlear aqueduct and anterior to the jugular bulb and extends to the medial end of the internal auditory canal. Air can be seen in the middle turn of the cochlea, indicating a pneumolabyrinth (white arrow). (B) Axial CT scan through the level of the lateral semicircular canal. The fracture line on the right side involves the ampulla of the lateral semicircular canal and connects to the orifice of the vestibular aqueduct. Air can be seen in the right utricle and in the left internal auditory canal. Also there are effusions in the well pneumatized mastoid cavities, bilaterally, and in the left sphenoid sinus. A A Fig. 2. Follow up imaging studies three months after the injury. (A) An enlarged axial CT scan of the left temporal bone through the level of the otic capsule shows no visible bony obstruction in the cochlear duct. (B) An enlarged axial T2 weighted MR scan shows a clearly visible frac- ture line with a hyposignal intensity which suggests fibrosis (white arrow). He then underwent a right cochlear implant procedure through a transmastoid facial recess approach. A HiRes 90K Cochlear Implant (Advanced Bionics, Boston Scientific) was implanted. The cochlear implant procedure was successful with no evidence of infection and other complications after the cochlear implan- tation. However, 14 of 16 electrodes were inserted due to the resistance. Following the mapping, programming, and aural rehabilita- tion, the patient’s listening skills to speech and environmental sounds improved. An implant-aided audiogram three months after the operation revealed responses in the region of 30 dB HL. Still about one and half year after the operation, he always wears the implant and understands 70% of the usual conversa- tion with his family. B B