After head trauma, a patient has haemotympanum, immediate complete facial paralysis and profound sensorineural hearing loss. CT shows a fracture crossing the otic capsule. Which statement is most accurate?
Otic-capsule-violating fractures are associated with sensorineural deafness, CSF leak and facial injury. Immediate complete paralysis particularly raises concern for severe nerve disruption and may require electrodiagnostic and surgical decision-making.
A. The fracture is low risk because it is longitudinal: Modern risk assessment is better based on otic-capsule involvement than the older orientation classification.
B. Conductive hearing loss is the only expected deficit: Inner-ear violation commonly causes profound sensorineural loss.
C. Facial function cannot be assessed until six months: Timing and completeness of palsy are immediately important.
D. No CSF-leak precautions are needed: Otic-capsule violation can create a persistent CSF pathway.
E. Otic-capsule violation predicts major inner-ear and facial-nerve morbidity and requires urgent specialist evaluation: Otic-capsule-violating fractures are associated with sensorineural deafness, CSF leak and facial injury. Immediate complete paralysis particularly raises concern for severe nerve disruption and may require electrodiagnostic and surgical decision-making.
If facial weakness were delayed and incomplete with preserved stimulation, oedema-related neuropraxia and conservative management would be more likely.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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