Otic Capsule Violating Research Articles

The Role of Temporal Bone Pneumatization on Fracture Line and Involved Cranial Structures.

Temporal bone pneumatization (TBP) is speculated to serve as a shock absorber in temporal bone fractures (TBF), directing the fracture line away from vital structures. This study correlates TBP extent with TBF patterns and preservations of vital TB structures. Retrospective cohort study. Tertiary referral medical center. All TBF patients referred to a single tertiary center 2017 to 2023 were evaluated. A pneumatization index score for each of their TBs was derived by counting automated-voxel density in a 0 to 100 scale. Results were correlated to the TBF type and the violated structure(s). The ossification index was compared to previously detailed qualitative classification systems of TBP. One hundred and forty-five patients were enrolled (mean age 43 ± 17 years). Kinematics were motor vehicle accidents (46%), scooter (15%), bicycle (14%), falls (13%), and assaults (8%). The mastoid ossification index we used showed a strong correlation to all qualitative classification systems (sigmoid = 0.829; labyrinthine = 0.849; carotis = 0.863, infralabyrinthine = 0.869, all P < .001). The pneumatization index strongly correlated with capsule-violating TBFs, with a mean of 44 ± 23 for otic capsule-sparing TBF and 61 ± 20 for otic capsule-violating (OCV) TBF (P < .001). The facial nerve was violated in 30 patients. Facial canal (FC) involvement was not correlated to the ossification index: it was 49 ± 23 for FC-sparing and 44 ± 23 for FC-violating (P = .620). TBP serves as a protective mechanism against OCV TBF. The more pneumatized the TB, the less likely the otic capsule will be violated in the event of a TBF with the exception of the carotid and FCs. TBP index is in strong agreement with qualitative TBP classification systems.

Otological manifestations of temporal bone fractures

Background: Temporal bone fractures are caused by high intensity trauma and can result in various facial and cochleovestibular sequelae, which can affect the quality of life. The aim was to study about the various otological manifestations of temporal bone fractures in head trauma patients. Methods: Descriptive study of 82 patients was conducted in the Department of Otorhinolaryngology, Government T D Medical College, Alappuzha from April 2019 to March 2021. All patients with radiological evidence of temporal bone fractures were taken for study and their symptoms and signs were compared among otic capsule sparing (OCS) and otic capsule violating (OCV) type fractures. Data was analysed statistically using SPSS version 22 and p value calculated using chi-square test. Results: Majority of the patients were in the 20–40-year age group. Male to female ratio was 8.1:1. The most common aetiology was road traffic accidents (RTAs) n=74 (90.24%). The incidence of tinnitus (p value=0.02), vertigo (p value=0.007), facial palsy (p value=0.0004), CSFO (p value=0.0002), nystagmus (p value=0.0065) and sensorineural hearing loss (SNHL) (p value=0.00001) were found to be more in OCV type fractures and their association was found to be statistically significant. The incidence of TM perforation (p value=0.01), conductive hearing loss (CHL) (p value=0.0008) and EAC laceration (p value=0.04) was more in OCS type fractures and was statistically significant. Conclusion: Rapid diagnosis of temporal bone fractures is crucial as it enables effective initial management aimed at avoiding the facial and cochleovestibular sequelae that can adversely affect the quality of life. Keywords: temporal bone; fracture; facial palsy; tinnitus; otological manifestation; sensorineural hearing loss

Complications After Pediatric Temporal Bone Fractures by Classification System: A Systematic Review and Meta-analysis.

To analyze the rates of complications after pediatric temporal bone fractures (TBF) and the utility of the longitudinal, transverse, and mixed versus the otic capsule sparing (OCS) and otic capsule violating (OCV) classification systems in predicting these complications. PubMed, Scopus, and CINAHL. Per PRISMA guidelines, studies of children with TBFs were included. Meta-analyses of proportions were performed. A total of 22 studies with 1376 TBFs were included. Children with TBF had higher rates of conductivehearingloss (CHL) than sensorineural hearing loss (SNHL) (31.3% [95% confidence interval [CI] 23.2-40.1] vs12.9% [95% CI 8.9-17.5]). No differences in both CHLand SNHL were seen between longitudinal and transverse TBFs; however, OCV TBFs had higher rates of SNHL than OCS TBFs (59.3% [95% CI 27.8-87.0] vs4.9% [95% CI 1.5-10.1]). Of all patients, 9.9% [95% CI 7.2-13.1] experienced facial nerve (FN) paresis/paralysis, and 13.4% [95% CI 5.9-23.2] experienced cerebrospinal fluid otorrhea. Transverse TBFs had higher rates of FN paresis/paralysis than longitudinal (27.7% [95% CI 17.4-40.0] vs8.6% [95% CI 5.2-12.8]), but rates were similar between OCS and OCV TBFs. CHL was the most common complication after TBF in children; however, neither classification system was superior in identifying CHL. The traditional system was more effective at identifying FN injuries, and the new system was more robust at identifying SNHL. While these results suggest that both classification systems might have utility in evaluating pediatric TBFs, these analyses were limited by sample size. Future research on outcomes of pediatric TBFs stratified by type of fracture, mainly focusing on long-term outcomes, is needed.

Delayed Hearing Recovery After Transverse Temporal Bone Fracture with Otic Capsule violation - Case Report and Literature Review

We present a patient who suffered a temporal bone fracture (TBF) encompassing the bony labyrinth. Sensorineural hearing loss was confirmed with an unfavorable prognosis for recovery. Thirteen years later, there is regression of the hearing loss.

Improved Prediction of Hearing Loss after Temporal Bone Fracture by Applying a Detailed Classification for Otic Capsule-Violating Fracture: A Wide Scope Analysis with Large Case Series.

This study aimed to analyze the predictability of temporal bone (TB) fracture-associated hearing loss by applying a detailed classification separating individual injury of the cochlea, vestibule, and semicircular canals (SCC). In this retrospective study, patients with otic capsule-violating (OCV) fractures were further classified as OCV-C(VS) when the cochlea was involved regardless of vestibule or SCC involvement, OCV-V(S) when the vestibule was involved regardless of SCC involvement, and OCV-S when the fracture only involved SCC. Hearing changes were compared by applying the above-mentioned classification, and TB fracture-induced facial palsy was also analyzed. A total of 119 patients were included. Patients with OCV fractures had significantly worse bone conduction (BC) and air conduction (AC) thresholds (59.1 ± 25.3 and 87.0 ± 29.5 dB) than those with otic capsule-sparing (OCS) fractures (20.1 ± 17.9 and 36.5 ± 21.9 dB; p < 0.001 for each comparison). The BC and the AC thresholds of OCV-C(VS) (77.5 ± 11.0 and 114.2 ± 14.3 dB) and OCV-V(S) (69.3 ± 27.7 and 98.0 ± 22.2 dB) were significantly higher than OCV-S (40.1 ± 22.9 and 62.1 ± 25.6 dB; p < 0.001 for each comparison). The BC hearing thresholds were not significantly improved in the last pure tone audiometry when compared for total, OCV, or OCS cases. The AC threshold significantly improved in OCS cases. In a considerable number of cases with facial palsy, causative fracture lines involved the geniculate ganglion or tympanic segment without the involvement of the otic capsule. Most cases showed significant improvement; however, recovery was limited in cases with obvious fallopian canal disruption. The cases with sole involvement of SCC had significantly better hearing thresholds than those with cochlear or vestibule involvement, even in OCV fracture cases.

Correlation of Temporal Bone Fracture on Computed Tomography Scan with Hearing Loss in Posttraumatic Patients

Introduction: Temporal bone fractures in adults are invariably due to motor vehicle accidents or road traffic accidents. Hearing loss is a common complaint following temporal bone fractures, but attention to it is frequently overlooked as there may be other life-threatening complications associated with it that may require immediate attention of the caregiver. Immediate detection of temporal bone fracture and its complications helps in providing early and effective treatment. Aim: The main objective of our study is to observe various types of fractures on multidetector computed tomography (CT), difference between various types, and classification of fractures of temporal bone with correlation between types of fracture and clinical hearing loss. Methods: Two-year (2019–2021) prospective study of head injured patients with temporal bone fracture presented to the Department of Radio-diagnosis (AVBRH, DMIMS, Wardha) with complaints of hearing loss was subjected for study. Temporal bone fracture patients satisfying inclusion and exclusion criteria having hearing loss were evaluated audiologically after a gap of 3 months following the initial injury once the patient was stable. Age and gender distribution, cause of injury, radiological findings, and clinical presentations were analyzed. Data were entered into Microsoft Excel data sheet and were analyzed using SPSS 22 version software. Results: Out of 173 patients having hearing loss with temporal bone fracture, majority of the patients were male (84.97%) and were between 20 and 39 years (46.24%) with a mean age of 41 years. The major cause of injury was motor vehicle accidents (84.39%). The right side was involved (49.1%) more than the left side (46.0%). Longitudinal type fracture was most frequent (64.74%). Otic capsule involvement was present in 9.25%. Conductive hearing loss was more common in otic capsule sparing and sensorineural hearing loss was more common in otic capsule-involved fractures. Otic capsule sparing was more common in (95.54%) longitudinal type of fracture. Otic capsule violation was more common in (26.09%) transverse type of fracture. Conclusion: This study suggests that image analysis of high-resolution CT can be used in fracture of temporal bone either to detect the hearing loss or to know the type and classify the fracture or to find the correlation between the types of fracture and clinical hearing loss.

Early Diagnosis of Hidden Hearing Loss Following Temporal Bone Fractures.

Temporal bone fracture accounts for 30-70% of skull fractures. Temporal bone trauma is associated with severe traumatic brain injury. Temporal bone fractures are invariably due to road traffic accidents (RTA). Temporal bone fractures are traditionally classified as transverse, longitudinal or mixed fractures depending on their relationship to the petrous pyramid. Recent studies classify temporal bone fractures as otic capsule sparing (OCS) and otic capsule violating (OCV) types and has more relevance with the prognosis of hearing loss and complications. To study of type and degree of hearing loss following temporal bone fractures according to the old and new classification of temporal bone fractures. The prospective study of 35 cases of head injuries attending emergency department was conducted in the Department of Otorhinolaryngology, SNMC and H.S.K. Hospital & Research centre, Bagalkot during the study period from January 2019 to June 2020. High Resolution Computed Tomography (HRCT) of bilateral temporal bone was done to look for type of temporal bone fractures. Pure tone audiometry (PTA) to assess degree and type of hearing loss. Appropriate statistical analysis at the end of study was done. Most patients were in age group of 21-40years. Among 35 cases, 30 were longitudinal fractures, 4 were transverse and 1 was mixed.27 cases were OCS and 8 of OCV type.OCV type of fractures are having higher degree of hearing loss. Longitudinal type of temporal bone fractures constitutes majority. Hearing loss was more in OCV type.

Assessment of hearing loss in temporal bone fractures

Introduction: Thirty percent to seventy percent of skull fractures in adult head trauma patients is due to temporal bone fractures and is caused due to road traffic accidents (RTAs). Temporal bone fractures are more commonly associated with hearing loss. Objective: The objective of this study is to assess the type and the amount of hearing loss in temporal bone fractures. Methodology: A 3-month retrospective study was conducted at the department of ear, nose, and throat in a tertiary care center. Fifty patients, diagnosed as cases of temporal bone fractures with hearing loss were included in the study. The patients with temporal bone fractures were categorized into two groups-otic-capsule sparing (OCS) and otic-capsule violating (OCV) fractures, and hearing loss was evaluated with Pure tone audiogram (PTA). Results: OCS fractures were more common (64%) than OCV. Conductive type of hearing loss was commonly associated with OCS, whereas sensorineural hearing loss was more common in OCV fractures. The average degree of hearing loss ranged from 20 to 68 db. The correlation was statistically significant for temporal bone fractures (OCS and OCV) with respect to hearing loss (P &lt; 0.00001). Other complications such as external auditory canal filled with blood, perforation of tympanic membrane, and hemotympanum were also observed in our study. Conclusion: Temporal bone fractures are most commonly due to RTAs and are frequently associated with severe brain injury. Classifying temporal bone fractures as OCS and OCV fractures correlates well with the severity of hearing loss, and conductive hearing loss was the most common type hearing loss.

Predicting complications of pediatric temporal bone fractures

ObjectiveOur aim is to characterize complications of pediatric temporal bone fractures and identify predictive risk factors associated with fracture complications. MethodsA retrospective review was conducted of all temporal bone fractures diagnosed in children (age less than or equal to 18 years) from a single academic institution between 2003 and 2017. Demographics, mechanism of injury, fracture characteristics, computed tomography evaluation and follow-up duration were recorded on each patient. Outcomes measured include facial nerve injury (FNI), cerebrospinal fluid (CSF) leak, sensorineural hearing loss (SNHL), and conductive hearing loss (CHL). ResultsOne-hundred-seventeen patients with 129 temporal bone fractures were included in the study. Most fractures were otic capsule sparing (OCS) (96%, n = 124) and longitudinal (71%, n = 91). Otic capsule violating (OCV) fractures were associated with higher CSF leak rates (20% versus 2%, p = 0.14) and FNI rates (60% versus 5%, p = 0.002) compared to OCS fractures. Audiograms were available in 37 patients (34%). Patients with Glasgow coma scale (GCS) consistent with a mild traumatic brain injury (TBI) (GCS > 13) had significantly fewer complications (FNI and CSF leaks) compared to the group with moderate and severe TBI (GCS < 13), 5% versus 23% (p = 0.03). ConclusionsHigher complication rates are seen with OCV fractures and transverse fractures. Moderate and severe TBI as measured by GCS is predictive of FNI and CSF complications in pediatric temporal bone fractures.

Posttraumatic Cranial Suture Diastasis in Pediatric Temporal Bone Fractures.

Only a handful of case reports exist describing posttraumatic sutural diastasis in the calvarium and none report concurrent temporal bone involvement. We aim to describe diastasis along the temporal bone suture lines in the setting of temporal bone trauma and to identify clinical sequelae. Retrospective case review. Tertiary Level 1 trauma center. Forty-four patients aged 18 and younger who suffered a temporal bone fracture from 2013 to 2018 were identified. Diastasis and diastasis with displacement at the occipitomastoid, lambdoid, sphenosquamosal and petro-occipital sutures, and synchondroses were determined. The presence of temporal bone suture and synchondrosal diastasis following temporal bone trauma. Diastasis was defined as sutural separation of a distance greater than 1 mm in comparison to the contralateral side. Using our diastasis diagnostic criteria, diastasis occurred in 41.5% of temporal bone fractures. Transverse fracture types were significantly associated with diastasis (p ≤ 0.001). Lower Glasgow Coma Scale (GCS) and loss of consciousness (LOC) were associated with the presence of diastasis with displacement and diastasis (p = 0.034 and p = 0.042, respectively). Otic capsule violation was more common in fractures with diastasis but did not reach statistical significance. There were two cases of cerebrospinal fluid otorrhea and three deaths in cases that featured diastasis. Our findings indicate that diastasis is a positive predictor for higher disruptive force injuries and more severe outcomes and complications. Posttraumatic temporal bone suture diastasis may represent a separate clinico-pathologic entity in addition to the usual temporal bone fracture classification types.

CI for Traumatic Sensorineural Hearing Loss Without Otic Capsule Violation

CI for Traumatic Sensorineural Hearing Loss Without Otic Capsule Violation

The potential protective effects of temporal bone pneumatization: A shock absorber in temporal bone fracture.

ObjectivesWe hypothesize that when temporal bone fractures occur, the pneumatic cells in the temporal bone are able to absorb most of the impact force during a traumatic event. This study aims to correlate the degree of pneumatization of the temporal bone with the severity of temporal bone fracture (TBF).MethodsCharts and computed tomography scans representing 54 TBFs, diagnosed from 2012 to 2017 at a single tertiary hospital, were retrospectively reviewed. Temporal bone pneumatization (TBP) in the petrous apex and mastoid region was evaluated using previously published classification systems. TBP classifications and fracture types were correlated with TBF complications such as sensorineural hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction.ResultsPatients with increased pneumatization of the temporal bone had significantly fewer and less severe SNHL. SNHL more strongly correlated with the degree of pneumatization in the mastoid (P = 0.005) than that in the petrous apex (P = 0.024). On the other hand, the degree of TBP correlated poorly with FNP and vestibular dysfunction. However, the mastoid hypopneumatization demonstrated significant correlation with otic-capsule violations (P = 0.002). Fractures with otic-capsule violation were 4 times more likely to have vestibular dysfunction (P = 0.043) and 3 times more likely to have SNHL (P = 0.006). FNP was not associated with otic-capsule violating fractures but was 3.5 times more common in comminuted fractures (P = 0.025).ConclusionsThe degree of temporal bone pneumatization was negatively correlated to the incidence of otic-capsule violation and the severity of hearing impairment in patients with temporal bone fracture. This study substantiated the potential protective effect of temporal bone pneumatization in TBFs.

Hearing loss in pediatric temporal bone fractures: Evaluating two radiographic classification systems as prognosticators

IntroductionTemporal bone fractures (TBF) are traditionally classified by their angle of fracture relative to the petrous ridge, and more recently by whether or not they violate the otic-capsule. This study compared rates of hearing loss (HL) and signs of otologic dysfunction among fracture types of both classification systems, within the pediatric population. MethodsPediatric patients were retrospectively characterized from a previously identified cohort of TBF patients, diagnosed from 2000 to 2014. CT scans were reviewed and TBFs were classified first as longitudinal (L), transverse (T) or mixed (M), and then as otic-capsule sparing (OCS) or otic-capsule violating (OCV). Medical records were reviewed, and rates of HL and presenting signs were compared among L, T and M fractures, and OCS and OCV fractures. ResultsForty-three patients with 47 TBFs met the inclusion criteria. Eighteen, 4 and 25 TBFs were classified as L, T and M fractures, respectively. Thirty-three and 9 were classified as OCS, and OCV, respectively. Among 24 cases of HL: 20, 3, and 1 were conductive HL (CHL), sensorineural HL (SNHL) and mixed HL, respectively. Two cases of SNHL were found among OCV fractures, with none in OCS fractures (estimated difference 0.22; 95% confidence interval 0.01–0.60). Similar rates of CHL were found across L, T and M fractures (range 36–50%), and across OCV and OCS fractures (range 42–44%). Hemotympanum was the most common presenting sign, found in 68% of TBFs and 80% of CHL cases. There were no significant differences in the incidence of signs or symptoms between fracture types. ConclusionsIn our cohort, both the traditional and otic-capsule radiographic classification systems failed to predict the incidence of CHL and other otologic signs in the pediatric population. Though OCV fractures conferred an increased risk for developing SNHL, we found a lower incidence than anticipated given violation to the bony labyrinth.

Hearing and Mortality Outcomes following Temporal Bone Fractures.

The aim of this article is to determine hearing and mortality outcomes following temporal bone fractures. Retrospective chart review was performed of 152 patients diagnosed with a temporal bone fracture presenting to the emergency room at a tertiary care referral center over a 10-year period. Utilizing Patients' previously obtained temporal bone computed tomographic scans and audiograms, fractures were classified based on several classification schemes. Correlations between fracture patterns, mortality, and hearing outcomes were analyzed using χ2 tests. Ossicular chain disruption was seen in 11.8% of patients, and otic capsule violation was seen in 5.9%; 22.7% of patients presented for audiologic follow-up. Seventeen patients with conductive hearing loss had air-bone gaps of 26 ± 7.5 dB (500 Hz), 27 ± 6.8 dB (1,000 Hz), 18 ± 6.2 dB (2,000 Hz), and 32 ± 7.7 dB (4,000 Hz). Two cases of profound sensorineural hearing loss were associated with otic capsule violation. No fracture classification scheme was predictive of hearing loss, although longitudinal fractures were statistically associated with ossicular chain disruption ( p < 0.01). Temporal bone fractures in patients older than 60 years carried a relative risk of death of 3.15 compared with those younger than 60 years. The average magnitude of conductive hearing loss resulting from temporal bone fracture ranged from 18 to 32 dB in this cohort. Classification of fracture type was not predictive of hearing loss, despite the statistical association between ossicular chain disruption and longitudinal fractures. This finding may be due to the low follow-up rates of this patient population. Physicians should make a concerted effort to ensure that audiological monitoring is executed to prevent and manage long-term hearing impairment.

Pediatric Temporal Bone Fractures: A 10-Year Experience.

The aim of the study was to compare the traditional and newer temporal bone fracture classification systems and their reliability in predicting serious outcomes of hearing loss and facial nerve (FN) injury. We queried the medical record database for hospital visits from 2002 to 2013 related to the search term temporal. A total of 1144 records were identified, and of these, 46 records with documented temporal bone fractures were reviewed for patient age, etiology and classification of the temporal bone fracture, FN examination, and hearing status. Of these records, radiology images were available for 38 patients and 40 fractures. Thirty-eight patients with accessible radiologic studies, aged 10 months to 16 years, were identified as having 40 temporal bone fractures for which the otolaryngology service was consulted. Twenty fractures (50.0%) were classified as longitudinal, 5 (12.5%) as transverse, and 15 (37.5%) as mixed. Using the otic capsule sparing (OCS)/violating nomenclature, 32 (80.0%) of fractures were classified as OCS, 2 (5.0%) otic capsule violating (OCV), and 6 (15.0%) could not be classified using this system. The otic capsule was involved in 1 (5%) of the longitudinal fractures, none of the transverse fractures, and 1 (6.7%) of the mixed fractures. Sensorineural hearing loss was found in only 2 fractures (5.0%) and conductive hearing loss (CHL) in 6 fractures (15.0%). Two fractures (5.0%) had ipsilateral facial palsy but no visualized fracture through the course of the FN canal. Neither the longitudinal/transverse/mixed nor OCS/OCV classifications were predictors of sensorineural hearing loss (SNHL), CHL, or FN involvement by Fisher exact statistical analysis (for SNHL: P = 0.37 vs 0.16; for CHL: P = 0.71 vs 0.33; for FN: P = 0.62 vs 0.94, respectively). In this large pediatric series, neither classification system of longitudinal/transverse/mixed nor OCS/OCV was predictive of SNHL, CHL, or FN palsy. A more robust database of audiologic results would be helpful in demonstrating this relationship.

Hearing loss following temporal bone fractures- a study on classification of fractures and the prognosis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Temporal bone fractures are traditionally classified as transverse, longitudinal or mixed fractures depending on their relationship to the petrous pyramid. However recent studies show that classifying temporal bone fractures as otic capsule sparing (OCS) and otic capsule violating (OCV) types has more relevance with the prognosis of hearing loss and other associated complications. To assess the predictive value of two different types of temporal bone fracture classification systems with respect to hearing loss and its type.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was done on patients attending a tertiary care hospital in the study period of one year. Temporal bone fracture patients satisfying inclusion and exclusion criteria were clinically and audiologically evaluated. All patients with temporal bone fractures were categorized into two groups - Longitudinal/ Transverse (old) and OCS / OCV (new). &lt;span lang="EN-IN"&gt;Hearing loss was evaluated audiologically on multiple intervals- initially following the injury once the patient is stable, later after a gap of 1 month and 3 months following the injury. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;During the study period, 45 patients presenting with temporal bone fractures who satisfied the selection criteria were evaluated. The correlation was statistically significant for new classification system (&lt;em&gt;P&lt;/em&gt;- 0.000) with respect to severity and prognosis of hearing loss which was not the case with the old system (&lt;em&gt;P&lt;/em&gt;- 0.450). &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We found that classifying temporal bone fractures into OCV and OCS correlates well with the severity of the hearing loss, the prognosis of the patient and the residual hearing disability when compared to the traditional system.&lt;/span&gt;&lt;/p&gt;

Outcomes in pediatric patients with recreational vehicle related forceful head impact

PurposeTo compare outcomes in pediatric patients suffering forceful head impact during recreational vehicle use to patients with forceful head impact from other mechanisms. MethodsRetrospective cohort study of all patients 3–18 years old who suffered forceful head impact (any traumatic mechanism strong enough to result in a face or skull fracture) in our institutional trauma registry between January 2011 and September 2013. ResultsOut of 252 events involving forceful head impact, 64 events were a result of riding a recreational vehicle. Although there is no difference in rates of temporal bone fractures, recreational vehicle accidents have higher rates of otic capsule violation (21% vs. 5%) and higher rates of hearing loss (30% vs 16%) compared to patients with forceful head impact from other mechanisms. All incidents of otic capsule violation and sensorineural hearing loss in recreational vehicle accidents were associated with a temporal bone fracture. ConclusionDespite the increasing use of head protective gear while operating a recreational motor vehicle there is still heightened risk for temporal bone fractures and subsequent hearing loss. The comparative associations in this study suggest that helmets used with recreational vehicles do not protect the temporal bone thus leaving vital structures within the otic capsule at risk for damage and long term consequences. When treating these patients Otolaryngologists should be aware of the elevated risk of otic capsule violation and late hearing loss with temporal bone fractures.

Pediatric temporal bone fractures: Current trends and comparison of classification schemes

1) Characterize the current presentation of pediatric temporal bone fractures, 2) compare two classification schemes for temporal bone fractures and illustrate complications in each fracture type. Retrospective medical record review. Tertiary-care, academic children's hospital. All children presenting from 1999 to 2009 with CT-proven temporal bone fracture and audiology examination with follow-up. All CT scans were reinterpreted by a dedicated head and neck radiologist. All fractures were characterized as otic capsule sparing (OCS) or otic capsule violating (OCV), as well as transverse (T) or longitudinal (L). CT findings, mechanisms of injury, sensorineural hearing loss (SNHL), conductive hearing loss (CHL), and facial nerve injury (FNI). Seventy-one children met inclusion criteria. Fifty-four (76%) children had longitudinal fractures versus 17 (24%) with transverse fractures. Sixty-four (90%) had OCS versus 7 (10%) with OCV. The otic capsule was involved in 7.4% of longitudinal fractures and 17.6% of transverse fractures. Eleven (15%) had facial weakness, 72% of whom had a visualized fracture through the facial nerve course. SNHL was detected in 14 (20%) patients and CHL in 17(23.9%). All patients with fractures classified as both transverse and OCV had SNHL. The OCS versus OCV and T versus L classification schemes were directly compared for statistical significance in predicting SNHL, CHL, and FNI using the Fisher's exact test. Both OCS/OCV and T/L were predictors of SNHL (P = .0025 and P = .0143, respectively), but the OCS/OCV scheme was more accurate. Neither classification significantly predicted CHL or FNI (P = .787 versus .825; P = .705 vs. .755). In this pediatric series, approximately 75% of the fractures are longitudinal and 25% are transverse. The otic capsule is spared in 90% and violated in 10%. Both OCS/OCV and L/T classification schemes predict SNHL, but the OCV/OCS scheme is more accurate in this prediction. Although the negative predictive value of the two schemes is similar, the positive predictive value is higher with the OCS/OCV system. The presence of conductive hearing loss and facial nerve symptoms was not predicted by either classification system.

Comparison of the Traditional and New Classification System of Temporal Bone Fractures for Clinical Relevance

Objective: The traditional classification of temporal bone fracture is subdivided into transverse, longitudinal, and mixed fracture. But questions have arisen about its limited correlation with clinical symptoms. Recent studies have been introduced, including petrous bone invasion and otic capsule violation. And a newer system is introduced about invasion of four areas of temporal bone. Method: Clinical records and computed tomography scans were reviewed retrospectively on patients diagnosed with temporal bone fractures for the last seven years. We evaluated correlations of clinical presentation with each category of temporal bone fracture. Results: A total of 129 temporal bone fracture patients were reviewed. In the traditional classification scheme, transverse fracture presented at a significantly higher rate of sensorineural hearing loss (SNHL). The invasion of petrous bone system showed a significantly higher rate of SNHL, dizziness, and perforation of the tympanic membrane. The otic capsule-based system demonstrated a statistically significant rate and severity of SNHL among patients with otic capsule violation ( P &lt; .05). Conclusion: Although the traditional classification scheme, otic capsule involvement, and four areas of temporal bone systems did not demonstrate clear clinical correlations, petrous bone involvement showed significant correlations. So a petrous involvement based scheme better reflects clinical aspects.

Radiographic Classification of Temporal Bone Fractures

To compare the traditional system of radiographic classification of temporal bone fractures (transverse vs longitudinal vs oblique) with a newer system (otic capsule violating vs otic capsule sparing) with respect to their ability to predict sequelae of temporal bone trauma. Retrospective chart and radiology review. University trauma center and Department of Otolaryngology-Head and Neck Surgery. Patients with temporal bone fractures. Clinic records and computed tomographic scans were reviewed to evaluate the clinical predictability of complications of temporal bone fractures. Complications of temporal bone fractures (ie, sensorineural hearing loss, conductive hearing loss, cerebrospinal fluid leakage, and facial nerve weakness) were recorded. Two classification schemes for temporal bone fractures were statistically analyzed and compared as to their ability to predict each complication. A total of 234 temporal bone fractures were identified; 30 cases met our strict criteria for inclusion. The traditional classification system of temporal bone fractures did not significantly predict temporal bone complications (P = .71). On the other hand, the otic capsule-based system did demonstrate statistically significant predictive ability (P < .001). Patients with otic capsule-violating fractures were 5 times more likely to have facial nerve injury, 25 times more likely to have sensorineural hearing loss, and 8 times more likely to have cerebrospinal fluid otorrhea than those with otic capsule-sparing fractures. The traditional radiographic classification system failed to demonstrate clinical predictability in our series. Furthermore, the newer system of classification (otic capsule sparing vs otic capsule violating) demonstrated statistically significant predictive ability for serious clinical outcomes associated with temporal bone fractures.