 All right, a little bit on trauma. We'll talk briefly about longitudinal versus transverse fractures, which is the traditional way of classifying these fractures, longitudinal and transverse. But at some point, we realized what we were trying to do with this classification scheme of longitudinal and transverse was to figure out whether the otocapsule, whether the inner ear was actually involved because transverse fractures tend to involve the inner ear and longitudinal fractures tend to avoid the inner ear. And then we just realized, why are we beating around the bush? Why don't we just answer the question? Is the otocapsule involved or not? So the newer terminology is otocapsule violating and otocapsule sparing fractures. So if you want to get straight to the point, just tell them whether the otocapsule is involved. I want to emphasize once again this concept of using the mastoid effusion to your benefit here. In the trauma setting, if you see material within the mastoid in the middle ear, do not assume that that is effusion, that that is infection. In a trauma setting, that is almost always going to be an indicator of a temporal bone fracture. And if all you have is a head CT and you see that effusion, get the dedicated temporal bone CT because there's probably going to be a fracture that you won't detect on those thick head CT images. Okay, longitudinal fractures. They run along the length, along the long axis of the temporal bone. They usually involve the middle ear. They tend to disrupt the ossicles, ossicular dislocations. They produce, thus, a conductive hearing loss. They may be associated with a facial palsy if the facial nerve is involved. They are more common than their transverse counterpart. And they require less force than the transverse fractures, which is why they're more common. Transverse fractures, on the other hand, run across the width of the temporal bone. They tend to involve the otocapsule, tend to involve the inner ear, and disrupt the otocapsule. By the way, when I say otocapsule, I'm talking about the bony inner ear. That's what I mean by otocapsule. The transverse fractures tend to cause sensorineural hearing loss because they've disrupted the inner ear. They, too, tend to cause facial palsy. So you don't get away from facial palsy with either of these two types of fractures. Transverse fractures are less common because they require high force trauma. Now, somewhere in between, there are oblique fractures. And most fractures have some degree of obliqueity. We try to make them either longitudinal or transverse. And sometimes we have no other 45 degrees. We call them oblique fractures. And that's really what led to that and alternate terminology of otocapsule sparing and otocapsule violating fractures. So here's an example of a longitudinal fracture of the temporal bone. You can see that it is running right through the middle ear and, in fact, the ice cream is off the cone. This is a malleo and cutial dislocation as the longitudinal fracture runs through the middle ear. This is the long axis of the temporal bone. Here is a classic transverse fracture. This is running across the axis of the temporal bone. You can see that it is then going to run straight into. Can't avoid the otocapsule. And, in fact, there is a fracture here. That's not actually the singular canal. In this case, it is a true transverse fracture into the vestibule. Sometimes we are left with an oblique fracture. You might think this is a transverse, but it doesn't quite hit the inner ear because it runs right behind it. And this is why that new terminology of otocapsule sparing and otocapsule violating is so useful. You could say that although this has a transverse orientation, it is otocapsule sparing. Don't forget to look for a singular dislocations in longitudinal fractures. This one is a nice obvious fracture where the ice cream is like a millimeter or two off of the cone. They're often much more subtle than this. Just slight asymmetry, slight widening of the malleo and cutial joint on one side or another. But I've shown you one that is a more clear case of a singular disruption. One other thing that's really important to look for in otocapsule violating fractures is to make sure that you haven't had leak of the endolymph and peri-lymph out of the inner ear with replacement of gas from the middle ear. This is a peri-lymphatic fistula. If you see gas in the cochlear vestibule, that's indicative of a peri-lymphatic fistula which is a very severe complication of these otocapsule violating fractures.