A Case of Bilateral Temporal Bone Fractures Treated With Cochlear Implantation and Customized Vestibular Rehabilitation.

Abstract

Bilateral temporal bone fractures (TBFs) involving the otic capsule are uncommon, but can result in simultaneous severe auditory and vestibular dysfunction. We present the case of a 59 year-old male patient who experienced bilateral hearing loss and vertigo following a backward fall from a height of 2 m. Temporal bone computed tomography scans revealed bilateral fractures involving the otic capsule with hemorrhage in both mastoid cavities. Audiologic evaluation confirmed bilateral profound sensorineural hearing loss, and vestibular testing indicated bilateral vestibular hypofunction. The patient underwent unilateral cochlear implantation (CI) on the left side, resulting in improved aided hearing thresholds (~45 dB HL) and enhanced verbal communication. He also participated in customized vestibular rehabilitation, comprising 4 sessions over 8 weeks. Clinical improvement was observed in balance confidence, visual acuity during head movement, and postural control tests. The Dizziness Handicap Inventory score decreased from 16 to 0, while the Activities-Specific Balance Confidence Score increased from 59% to 78%. This case emphasizes the importance of integrated auditory and vestibular rehabilitation in patients with bilateral TBFs, demonstrating that CI combined with vestibular therapy can facilitate significant functional recovery.