Management of Temporal Bone Fractures

Neurotrauma ◽  
2019 ◽  
pp. 103-112
Author(s):  
Hongzhao Ji ◽  
Brandon Isaacson
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Surgical Decompression ◽  
Vascular Injuries ◽  
Surgical Exploration ◽  
Mixed Hearing Loss ◽  
Csf Leakage ◽  
Spontaneous Improvement ◽  
Fluid Leak

Temporal bone fractures can present with a variety of symptoms and physical exam findings. Facial paralysis, hearing loss, spinal fluid leak, vestibular dysfunction, and vascular injuries are all potential issues that may occur in the setting of skull base trauma. The indications and interpretation of facial nerve electrophysiology studies with respect to the need for surgical decompression or repair are reviewed. Injuries to the middle and inner ear may result in conductive, mixed, or pure sensorineural hearing loss depending on the location of the fracture. Surgical repair of conductive or mixed hearing loss should be delayed because spontaneous improvement often occurs. CSF leakage presents with clear or serosanguineous aural discharge and typically resolves with conservative measures. Occasionally spinal fluids leaks require lumbar subarachnoid drainage or surgical exploration and repair. Evaluation and management of other issues arising as a result of temporal bone trauma will also be reviewed.

scholarly journals Bilateral temporal bone fractures: a case report

2017 ◽  
Vol 4 (1) ◽  
pp. 271
Author(s):  
Kiran Natarajan ◽  
Koka Madhav ◽  
A. V. Saraswathi ◽  
Mohan Kameswaran
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Paralysis ◽  
Bone Fractures ◽  
Clinical Manifestations ◽  
Csf Leak ◽  
The Right ◽  
Temporal Bones

<p>Bilateral temporal bone fractures are rare; accounting for 9% to 20% of cases of temporal bone fractures. Clinical manifestations include hearing loss, facial paralysis, CSF otorhinorrhea and dizziness. This is a case report of a patient who presented with bilateral temporal bone fractures. This is a report of a 23-yr-old male who sustained bilateral temporal bone fractures and presented 18 days later with complaints of watery discharge from left ear and nose, bilateral profound hearing loss and facial weakness on the right side. Pure tone audiometry revealed bilateral profound sensori-neural hearing loss. CT temporal bones &amp; MRI scans of brain were done to assess the extent of injuries. The patient underwent left CSF otorrhea repair, as the CSF leak was active and not responding to conservative management. One week later, the patient underwent right facial nerve decompression. The patient could not afford a cochlear implant (CI) in the right ear at the same sitting, however, implantation was advised as soon as possible because of the risk of cochlear ossification. The transcochlear approach was used to seal the CSF leak from the oval and round windows on the left side. The facial nerve was decompressed on the right side. The House-Brackmann grade improved from Grade V to grade III at last follow-up. Patients with bilateral temporal bone fractures require prompt assessment and management to decrease the risk of complications such as meningitis, permanent facial paralysis or hearing loss. </p>

scholarly journals Traumatic dislocation of middle ear ossicles: A new computed tomography classification predicting hearing outcome

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245796
Author(s):  
Georgios Mantokoudis ◽  
Njima Schläpfer ◽  
Manuel Kellinghaus ◽  
Arsany Hakim ◽  
Moritz von Werdt ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Outcome Prediction ◽  
Conductive Hearing Loss ◽  
Bone Fractures ◽  
Ct Scans ◽  
Axis Deviation ◽  
Joint Dislocation ◽  
Hearing Outcome ◽  
Conductive Hearing

Objectives To assess the feasibility of radiologic measurements and find out whether hearing outcome could be predicted based on computer tomography (CT) scan evaluation in patients with temporal bone fractures and suspected ossicular joint dislocation. Methods We assessed 4002 temporal bone CT scans and identified 34 patients with reported ossicular joint dislocation due to trauma. We excluded those with no proven traumatic ossicular dislocation in CT scan and patients with bilateral temporal bone fractures. We measured four parameters such as malleus-incus axis distance, malleus-incus angle at midpoints, malleus- incus axis angle and ossicular joint space. The contralateral healthy side served as its own control. Hearing outcome 1–3 months after the index visit was analyzed. We assessed diagnostic accuracy and performed a logistic regression using radiologic measurement parameters for outcome prediction of conductive hearing loss (defined as >20dB air-bone gap). Results We found excellent inter-rater agreement on the measurement of axis deviation between incus and malleus in CT scans (interclass correlation coefficient 0.81). The larger the deviation of incus and malleus axis, the higher probability of poor hearing outcome (odds ratio (OR) 2.67 per 0.1mm, p = .006). A cut-off value for the axis deviation of 0.25mm showed a sensitivity of 0.778 and a specificity of 0.94 (p < .001) for discrimination between poor and good hearing outcome in terms of conductive hearing loss. Conclusion Adequate assessment of high resolution CT scans of temporal bone in which ossicular chain dislocation had occurred after trauma was feasible. Axis deviations of the incus and the malleus were strongly predictive for poor hearing outcome in terms of air conduction 1–3 months after trauma. We propose a 3-level classification system for hearing outcome prediction based on radiologic measures.

scholarly journals Revisión bibliográfica de la detección temprana de luxación incudomaleolar mediante imágenes tomográficas

Medunab ◽  
2016 ◽  
Vol 18 (3) ◽  
pp. 213-217
Author(s):  
Lady Yadira Reyes-Álvarez ◽  
Federico Lubinus-Badillo ◽  
Evelyn Zuñiga-Hadechni ◽  
Ilich Fabián Plata-Cano ◽  
Jean Fabio Plata-Cano
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Conductive Hearing Loss ◽  
Bone Fractures ◽  
Calidad De Vida ◽  
Ear Ossicles ◽  
Conductive Hearing

Introducción: Esta revisión hace énfasis en la luxación incudomaleolar. Aunque poco frecuente, es una patología con gran relevancia clínica debido a la afectación de la audición a corto y mediano plazo en los pacientes, afectando así su calidad de vida, por lo que es necesario un diagnóstico oportuno para un tratamiento temprano y eficaz. Objetivo: describir los hallazgos imagenológicos e identificar los diferentes mecanismos etiológicos de la luxación incudomaleolar. Metodología: Se realizó una revisión bibliográfica en PubMed de los artículos publicados hasta febrero de 2015 con las palabras claves: “Ear ossicles”; “Temporal bone”; “Bone”; “Fractures”; “Dislocation”; “Conductive hearing loss”. Se encontraron 352 artículos de los cuales se seleccionaron aquellos donde se menciona la luxación incudomaleolar. Resultados: Se revisaron los abstracts de los 352 artículos, encontrando 20 donde mencionaban la definición, la epidemiología, la clínica y el diagnóstico imagenológico de la luxación incudomaleolar, los cuales fueron utilizados para la elaboración de esta revisión. Conclusiones: La principal causa de daño en la cadena de huesecillos es la fractura del hueso temporal y dentro de las patologías que puede generar está la luxación incudomaleolar, por lo que es de interés el diagnóstico temprano a todos los pacientes con sospecha clínica para llegar a prevenir complicaciones. La revisión de la literatura permite concluir que la técnica más eficaz para la identificación de la luxación Incudomaleolar es la tomografía computarizada, la cual requiere una adecuada identificación en los diferentes cortes multiplanares, o en las reconstrucciones 3D para poder diagnosticarla. [Lubinus-Badillo F, Zuñiga-Hadechni E, Reyes-Álvarez LY, Plata-Cano IF, Plata-Cano JF. Revisión bibliográfica de la detección temprana de luxación incudomaleolar mediante imágenes tomográficas. MedUNAB 2016; 18(3): 213-217].

Contralateral sensorineural deafness in the absence of temporal bone fractures: an ignored entity in traumatic brain injury

2021 ◽  
Vol 7 (6) ◽  
pp. 1055
Author(s):  
Marie Christy Sharafine Stephen ◽  
Anju Venugopalan ◽  
Nagaraj Bangalore Thimmasettaiah
Keyword(s):  
Traumatic Brain Injury ◽  
Hearing Loss ◽  
Brain Injury ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Sensorineural Deafness ◽  
Contralateral Side ◽  
Profound Deafness ◽  
Two Wheeler ◽  
The Brain

<p class="abstract">Traumatic brain injury (TBI) associated with temporal bone fractures causing ipsilateral hearing loss is not uncommon. But contralateral sensorineural hearing loss (SNHL) in the absence of temporal bone fractures is not frequently encountered or looked for in TBI patients. A simple bed side tuning fork test followed by a formal audiogram underscore the importance of pre-emptive assessment to prevent a permanent handicap. We report a case of a young man with no prior ear disease or comorbidities, who sustained traumatic brain injury with right parieto-temporal hemorrhagic contusion and cervical myelopathy following a two-wheeler fall. Although, there was no evidence of temporal bone fractures, he developed sudden profound deafness on the contralateral side of the brain injury. Evaluation and treatment for the same were initially delayed as the management solely focused on his neurological complaints and as the hearing loss was contralateral it was perceived to be unrelated to his brain injury. We want to highlight the importance of thorough evaluation and screening for bilateral hearing loss in patients with TBI irrespective of the presence or absence of temporal bone fractures to initiate appropriate management. We also want to add our patient to the very few such cases reported in the literature. We analyzed these cases and reviewed the possible pathophysiological mechanisms behind this entity.</p><p> </p>

Clinical features and radiological evaluation of otic capsule sparing temporal bone fractures

2017 ◽  
Vol 131 (3) ◽  
pp. 209-214 ◽  
Author(s):  
S W Song ◽  
B C Jun ◽  
H Kim
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Facial Paralysis ◽  
Bone Fractures ◽  
Regional Analysis ◽  
Pure Tone Audiometry ◽  
Type I ◽  
Otic Capsule ◽  
Type Iv ◽  
Temporal Bones

AbstractObjective:To evaluate the clinical and radiological aspects of otic capsule sparing temporal bone fractures.Methods:Using medical records, 188 temporal bones of 173 patients with otic capsule sparing temporal bone fractures were evaluated. Otoscopic findings and symptoms, facial paralysis, and hearing loss were assessed.Results:Using regional analysis, 7 fractures were classified as type I, 85 as type II, 169 as type III and 114 as type IV. Fourteen of the 17 facial paralysis cases improved to House–Brackmann grade II or lower at an average of 57.6 days after the initial evaluation. Thirty-one patients underwent initial and follow-up pure tone audiometry examinations. The air–bone gap closed significantly from 27.2 dB at an average of 21.8 days post-trauma to 19.6 dB at an average of 79.9 days post-trauma, without the need for surgical intervention.Conclusion:Initial conservative treatment for facial paralysis or conductive hearing loss is possible in otic capsule sparing fracture cases after careful evaluation of the patient.

scholarly journals Contralateral Cochlear Labyrinthine Concussion without Temporal Bone Fracture: Unusual Posttraumatic Consequence

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
I. M. Villarreal ◽  
D. Méndez ◽  
J. M. Duque Silva ◽  
P. Ortega del Álamo
Keyword(s):  
Hearing Loss ◽  
Head Injury ◽  
Sensorineural Hearing Loss ◽  
Temporal Bone ◽  
Head Trauma ◽  
Bone Fractures ◽  
Contralateral Side ◽  
Sensorineural Hearing ◽  
Temporal Bone Fracture ◽  
Blunt Head Trauma

Introduction. Labyrinthine concussion is a term used to describe a rare cause of sensorineural hearing loss with or without vestibular symptoms occurring after head trauma. Isolated damage to the inner ear without involving the vestibular organ would be designated as a cochlear labyrinthine concussion. Hearing loss is not a rare finding in head trauma that involves petrous bone fractures. Nevertheless it generally occurs ipsilateral to the side of the head injury and extraordinarily in the contralateral side and moreover without the presence of a fracture.Case Report. The present case describes a 37-year-old patient with sensorineural hearing loss and tinnitus in his right ear after a blunt head trauma of the left-sided temporal bone (contralateral). Otoscopy and radiological images showed no fractures or any abnormalities. A severe sensorineural hearing loss was found in his right ear with a normal hearing of the left side.Conclusion. The temporal bone trauma requires a complete diagnostic battery which includes a neurotologic examination and a high resolution computed tomography scan in the first place. Hearing loss after a head injury extraordinarily occurs in the contralateral side of the trauma as what happened in our case. In addition, the absence of fractures makes this phenomenon even more unusual.

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