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

A. Bhindi, L. Carpineta, B. Al Qassabi, S. Waissbluth, R. Ywakim, J. J. Manoukian, L. H.P. Nguyen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Temporal 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. Methods: Pediatric 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. Results: Forty-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. Conclusions: In 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.

Original languageEnglish
Pages (from-to)158-163
Number of pages6
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume109
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Temporal Bone
Bone Fractures
Hearing Loss
Capsules
Ear
Pediatrics
Incidence
Mixed Conductive-Sensorineural Hearing Loss
Conductive Hearing Loss
Sensorineural Hearing Loss
Inner Ear
Population
Signs and Symptoms
Medical Records

Keywords

  • Hearing loss
  • Otic-capsule
  • Pediatric head trauma
  • Temporal bone fracture

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

Hearing loss in pediatric temporal bone fractures : Evaluating two radiographic classification systems as prognosticators. / Bhindi, A.; Carpineta, L.; Al Qassabi, B.; Waissbluth, S.; Ywakim, R.; Manoukian, J. J.; Nguyen, L. H.P.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 109, 01.06.2018, p. 158-163.

Research output: Contribution to journalArticle

Bhindi, A. ; Carpineta, L. ; Al Qassabi, B. ; Waissbluth, S. ; Ywakim, R. ; Manoukian, J. J. ; Nguyen, L. H.P. / Hearing loss in pediatric temporal bone fractures : Evaluating two radiographic classification systems as prognosticators. In: International Journal of Pediatric Otorhinolaryngology. 2018 ; Vol. 109. pp. 158-163.
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abstract = "Introduction: Temporal 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. Methods: Pediatric 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. Results: Forty-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. Conclusions: In 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.",
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T1 - Hearing loss in pediatric temporal bone fractures

T2 - Evaluating two radiographic classification systems as prognosticators

AU - Bhindi, A.

AU - Carpineta, L.

AU - Al Qassabi, B.

AU - Waissbluth, S.

AU - Ywakim, R.

AU - Manoukian, J. J.

AU - Nguyen, L. H.P.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Introduction: Temporal 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. Methods: Pediatric 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. Results: Forty-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. Conclusions: In 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.

AB - Introduction: Temporal 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. Methods: Pediatric 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. Results: Forty-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. Conclusions: In 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.

KW - Hearing loss

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KW - Pediatric head trauma

KW - Temporal bone fracture

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