Abstract
The aim of study is to investigate the risk of developing acquired cholesteatoma and external auditory canal (EAC) stenosis after traumatic brain injury (TBI) from the Taiwan National Health Insurance Research Database (NHIRD). Each subject was individually traced from their index date to identify those who received a diagnosis of acquired cholesteatoma and EAC stenosis. Cox regression analyses were applied to determine the risk of TBI-related acquired cholesteatoma and EAC stenosis. The follow-up data collected over 10 years were obtained from the TBI and comparison cohorts, of 455,834 and 911,668 patients, respectively. Multivariate analysis demonstrated that TBI significantly increased the risk of cholesteatoma (adjusted hazard ratio (HR), 1.777; 95% confidence interval (CI), 1.494−2.114, p < 0.001) and EAC stenosis (adjusted (HR), 3.549; 95% (CI), 2.713−4.644, p < 0.001). In our subgroup injury analysis, falls had the highest associated risk (4.308 times), followed by traffic injuries (66.73%; 3.718 times that of the control group). Otolaryngologists should not neglect the clinical importance and carefully investigate the possibility of subsequent cholesteatoma and EAC stenosis, which leads to hearing impairment in patients with TBI. Our research also shows the important role in preventing TBI, especially as a result of traffic injuries and falls.
Highlights
Traumatic brain injury (TBI) may lead to temporal bone fracture
Over 66% of the injuries in our study causing acquired cholesteatoma and external auditory canal (EAC) stenosis in the traumatic brain injury (TBI) group were the result of traffic injuries
Based on a subgroup analysis, we determined the causes of TBI that resulted in acquired cholesteatoma and EAC stenosis, such as traffic injuries and falls
Summary
Traumatic brain injury (TBI) may lead to temporal bone fracture. In 1994, Kelley and Tami classified temporal bone fractures as otic capsule-sparing or otic capsule-disrupting rather than longitudinal or transverse fractures due to the better applicability of this classification for both prognosis prediction and treatment [1]. Dahiya et al reported that only 5.6% of patients with head injury had otic capsule-disrupting fractures. Compared with otic capsule-sparing fractures, otic capsule-disrupting fractures had seven times the probability of causing profound hearing loss [2]. Acquired cholesteatoma and external auditory canal (EAC) stenosis may result from temporal bone fracture and cause hearing loss. Hearing loss causes a significant inconvenience in daily life
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