HSC Section 8_April 2017

Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 154(1):175-180.

Original Research—Pediatric Otolaryngology

Otolaryngology– Head and Neck Surgery 2016, Vol. 154(1) 175–180 American Academy of Otolaryngology—Head and Neck

Audiometric Outcomes in Pediatric Temporal Bone Trauma

Surgery Foundation 2015 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815609114 http://otojournal.org

Amy Schell, MD 1 , and Dennis Kitsko, DO 1,2

Received April 30, 2015; revised September 4, 2015; accepted September 9, 2015. T emporal bone fractures are the most common type of skull base fracture in pediatric trauma. 1 The potential complications associated with temporal bone frac- tures are myriad, including facial nerve paresis and other cranial nerve palsies, sensorineural hearing loss (SNHL), conductive hearing loss (CHL), balance disturbances, tinni- tus, cerebrospinal fluid leaks, meningocele, encephalocele, cholesteatoma, and meningitis. 2 Additionally, fractures of the skull base are potentially fatal. Head injury is one of the leading causes of death in the pediatric age group. 1 Although temporal bone trauma and its related effects are common among pediatric patients, literature regarding audio- metric outcomes in this age group is lacking. Additionally, many protocols used to manage the aforementioned compli- cations are derived from adult patient experience. 1 Aspects of temporal bone and other skull base trauma may be fundamen- tally different among younger patients due to differing skull flexibility. 3 Hearing loss is a common consequence of temporal bone trauma that may have special implications in the pediatric population. Thirty-one percent of children with even unilat- eral SNHL have been shown to ‘‘experience scholastic or behavioral problems at school.’’ 4 Early recognition of hear- ing loss, especially in children, is imperative and can greatly decrease associated morbidity. 5 Historically, temporal bone fractures have been described in terms of the fracture axis in relation to the long axis of the petrous bone, as either transverse or longitudinal. Even when an oblique category is included, this system insuffi- ciently describes many clinically observed fractures. 6 Additionally, this system correlates poorly with clinical out- comes. 7,8 For these reasons, multiple other classification 1 UPMC Department of Otolaryngology, Pittsburgh, Pennsylvania, USA 2 Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA This article was presented as a poster at the American Society of Pediatric Otolaryngology Spring Meeting (Combined Otolaryngology Spring Meetings); April 24, 2015; Boston, Massachusetts. Corresponding Author: Dennis Kitsko, DO, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Seventh Floor, Faculty Pavilion, Pittsburgh, PA 15224, USA. Email: Dennis.Kitsko@chp.edu

No sponsorships or competing interests have been disclosed for this article.

Abstract Objective. To characterize pediatric temporal bone trauma, focusing on audiometric outcomes.

Study Design. Case series with chart review.

Setting. Tertiary care children’s hospital. Subjects and Methods. Cases were reviewed of children ( \ 18 years) presenting over a 3-year period with computed tomography–proven temporal bone fracture and audiology examination. All scans were read by a neuroradiologist and reviewed by a pediatric otolaryngologist. Demographics, fracture pattern, and audiometric data were recorded. Results. Fifty-eight patients (60 fractures) met inclusion cri- teria. The majority (93%) were otic capsule–sparing frac- tures. The types and severity of hearing loss were significantly different between the 2 fracture patterns. Based on pure-tone average, all otic capsule–violating fractures had abnormal initial audiograms; 75% of these losses were severe. Approximately half (54%) of otic capsule–sparing fractures had abnormal initial audiograms; a majority were mild losses (85%). All classifiable losses in otic capsule– violating cases were of mixed type, whereas the majority (75%) of losses in otic capsule–sparing cases were conduc- tive. Regardless of classification, 72% of patients with otic capsule–sparing fractures and initially abnormal audiograms improved to normal levels at a mean of 48 days posttrauma; this increased to 83% when only conductive losses were considered. Conclusions. Hearing loss type and severity differ in otic capsule–sparing and otic capsule–violating temporal bone fractures. A majority of children with otic capsule–sparing fractures and associated hearing loss improve to normal levels in about 6 weeks, especially if the original loss is clas- sified as solely conductive. Children who do not improve within this time frame may warrant early investigation into surgically correctable causes. Keywords temporal bone fracture, otic capsule–violating, otic capsule– sparing, conductive hearing loss, sensorineural hearing loss, mixed hearing loss

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