Otological manifestations in head injury and their management - a case report

Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis

The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission. The authors sought to evaluate the incidence of TTMR according to external injury cause and evaluate the association of skull fracture patterns with TTMR using a national trauma database. A cross-sectional analysis of trauma encounters was conducted using the National Trauma Data Bank (NTDB) from 2008 to 2015. Demographic and injury data were abstracted. Poisson regression was used to determine the incidence rate ratios of tympanic membrane rupture by external injury cause and logistic regression was used to estimate odds ratios (OR) of TTMR by skull fracture type. A total of 8214 patients were identified with TTMR during acute admission. The majority were on average 30 years old, 76% male, 71% White, had a mean Injury Severity Score of 14, and 42% were admitted to level I centers. The incidence rate ratio was only higher in lightning related injuries [5.262; 95% confidence interval (CI): 4.194-6.602] when using those caused by explosives as a reference. Basilar skull (OR: 12.95; 95% CI: 12.095-12.866) and cranial vault (OR: 2.938; 95% CI: 2.647-3.260) fractures were most associated with TTMR. The high incidence TTMR in association with certain external causes of injury and types of skull fractures should drive screening in the acute setting in order to increase detection and reduce morbidity from missed injuries.

Otological Manifestations in Head Injury: Experience from a Tertiary Academic Centre

Head injuries are most commonly associated with serious otolaryngological involvement. This study was done to identify the otological manifestations and its sequelae among patients with head injury. A prospective study conducted in a tertiary care centre, among patients attending the Emergency medicine, Otorhinolaryngology and Neurosurgery departments from August 2017-July 2018 with head injury and associated otological manifestations. They were examined within 48 hours of admission and followed up for two months. There were 243 patients with head injury, among which 201 were male and 42 were female patients. Majority of them (44.8%) were between 21 and 40 years of age. Road traffic accidents (RTA) was the commonest cause of head injury occurring in 91.8% patients. Among them, 58 patients (23.9%) had otological manifestations, the most common symptom and sign being ear bleed (72.4%) and temporal bone fracture (46.6%) respectively followed by facial nerve palsy (24.1%) and hearing loss (22.4%). Temporal bone fracture had statistically significant association with ear bleed, hearing loss, facial palsy and CSF otorrhoea (p = 0.0001) and tympanic perforation (p = 0.03). Otological involvement occurred in almost one fourth of the patients with head injury, the most common serious complication being temporal bone fractures which was diagnosed in almost half of this population followed by facial nerve palsy. Ear bleed, hearing loss and CSF otorrhea are significant indicators of underlying temporal bone fractures, necessitating early ENT evaluation and HRCT temporal bones for timely detection and prevention of disabling otological complications.

Otorhinolaryngological manifestations in head trauma: A prospective study of the epidemiology, clinical presentations, management, and outcomes

Background

Otorhinolaryngological injuries following head trauma may be missed, overlooked, or forgotten in the acute phase resulting in worsened management outcomes. This study aims to report the epidemiology, clinical presentations, management, and outcomes of otorhinolaryngological injuries in head trauma with a view to creating awareness for early recognition and prompt treatment.

Patients and Methods

Head injured patients consecutively presenting over a 5-year period were prospectively studied for age, gender, otorhinolaryngological presentations, interventions, and outcome of interventions. Data obtained were statistically analyzed.

Results

There were 91 (1.3%) otorhinolaryngological presentations among 7109 head injured patients. Mean age of 34 years, standard deviation = ±15.6 with a male:female ratio of 2.4:1. Severe head injury (Glasgow coma scale <9) occurred in 46 (50.5%) patients. Patients aged 30-39 years were mostly affected (n = 30; 32.9%). Most injuries were from motor vehicular accidents (n = 61; 67%) and assaults (n = 23; 25.3%). The most common otorhinolaryngological presentations were cerebrospinal fluid (CSF) rhinorrhea (n = 26; 28.6%) and CSF otorrhea (n = 25; 27.5%). Conservative management was achieved in 59.3% of patients. Mean time of hospital presentation was 13.8 h. There was no statistical correlation between outcomes and each of etiology and time of presentation (P values 0.18 and 0.9, respectively). Seventy-five (82.4%) were discharged without neurological deficits. A case fatality rate of 6.6% was recorded.

Conclusion

Frontal skull base and temporal bone fractures with CSF rhinorrhea and otorrhea are the most common injuries occurring mostly in young active males with favorable outcomes following conservative management.