The total number of temporal bone fractures is decreasing, however more casualties are surviving their injuries and require otolaryngological input. Due to often multi-system injury, patients should be initially managed according to Advanced Trauma Life Support principles. Common sequelae include conductive or sensorineural hearing loss, facial nerve injury, cerebrospinal fluid leak, vertigo and tinnitus. High resolution CT is the investigation of choice, using 1-1.5 mm slices in the coronal and axial planes. Immediate, delayed and late complications of temporal bone trauma are discussed, including the controversy surrounding management of facial nerve weakness. 7-10 % of temporal bone fractures are complicated by facial nerve weakness. A framework for patient evaluation is suggested.