Clinical and Experimental Otorhinolaryngology Vol. 1, No. 3: 171-173, September 2008 DOI 10.3342/ceo.2008.1.3.171 Case Report Cochlear Implantation after Bilateral Transverse Temporal Bone Fractures Jong-Heon Shin, MD SooChan Park, MD Sam-Hyun Baek, MD SungHee Kim, MD Department of Otolaryngology, Daegu Fatima Hospital, Daegu, Korea Patients deafened by a severe head injury are rarely encountered. We report a case of a 65-yr-old man with bilateral transverse temporal bone fractures due to head injury. He underwent cochlear implant and achieved a satisfactory audi- tory rehabilitation. Imaging studies of temporal bone before performing a cochlear implantation provide important infor- mation on a patient with bilateral temporal bone fractures. Cochlear implantations with careful planning in such a patient may be a very effective method for aural rehabilitation. Key Words. Temporal bone, Skull fractures, Sensorineural hearing loss, Cochlear implantation INTRODUCTION Temporal bone fractures often cause a loss of the audiovesti- bular function (1). Those patients with bilateral profound sen- sorineural hearing losses secondary to temporal bone fractures may become candidates for a cochlear implantation (2, 3). Com- petent assessment of the anatomy and pathology of the middle and inner ears are essential for any patient being considered for a cochlear implant. We present a case of a 65-yr-old male with bilateral profound sensorineural hearing loss caused by bilateral temporal bone fractures who achieved a satisfactory auditory rehabilitation after a cochlear implantation. CASE REPORT A 65-yr-old male presented to the emergency department with acute mental changes after a traffic accident on September 16, 2006. He was hit by a car while riding a motorcycle. On physi- cal examination, he exhibited a stuporous mental state. There were positive light reflexes on both sides, but no spontaneous nystagmus. He had bilateral ear bleeding and multiple contu- sions on his body. An otologic examination revealed a bilateral hemotympanum. The function of the other cranial nerves was Received May 23, 2008 Accepted after revision June 6, 2008 Corresponding author : SungHee Kim, MD, PhD Department of Otolayngology, Daegu Fatima Hospital, 183 Ayang-ro, Dong-gu, Daegu 701-600, Korea Tel : +82-53-940-7355, Fax : +82-53-954-7417 E-mail : sungheekim@fatima.or.kr 171 impossible to check due to his stuporous mental state. An emergency brain CT scan revealed a hemorrhage in the left temporal subarachnoid space with a pneumocephalus. A high resolution CT scan of the temporal bone revealed bilateral transverse temporal bone fractures involving the otic capsules with evidence of a bilateral pneumolabyrinth (Fig. 1). The frac- ture line extended to the internal auditory canal on the left side and was associated with a pneumocephalus in the internal audi- tory canal. He was admitted to the neurosurgical department for conser- vative treatment. Two days after the trauma, he exhibited an alert mental state with a complete bilateral hearing loss. No facial asymmetry or weakness was observed. Audiometry was performed 25 days after the trauma. There was no reliable response to the application of a pure tone or speech stimuli at the maximum limits of the audiometer. Immi- tance audiometry revealed a type A tympanometry on both sides. Vestibular function testing revealed the absence of any caloric responses bilaterally with ice water. The patient was offered a cochlear implant soon after the trauma. However, he accepted the fact that his deafness was permanent near three months after the trauma and decided to get an operation of cochlear implantation. Follow-up audiome- try revealed similar to the previous one, except residual hearing response at 500, 1,000, and 2,000 Hz on the right side. A repeat- ed high-resolution CT scan of the temporal bones was obtained which showed no evidence of labyrinthitis ossificans or oblitera- tion of the mastoid cavity, facial recess, or middle ear space. However, T2-weighted MR image showed a focal low-intensity lesion suggesting fibrosis in the lumen of the left cochlea (Fig. 2). The right ear was selected as the side for the implantation.