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Daloiso A, Franz L, Mondello T, Pavone C, Spinato G, Emanuelli E, Cazzador D, de Filippis C, Zanoletti E, Marioni G. Post-traumatic Delayed Facial Nerve Palsy: Report of 2 Cases and Systematic Review. Otolaryngol Head Neck Surg 2024. [PMID: 38769871 DOI: 10.1002/ohn.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/13/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Delayed facial nerve palsy (dFNP) secondary to head injury is definitely uncommon. Although the mechanism of immediate facial nerve paralysis is well-studied, its delayed presentation remains debated. Given the dearth of available information, we reported herein our experience with 2 cases of posttraumatic dFNP. This systematic review aimed to evaluate all available information on dFNP and to assess treatment outcome also comparing conservatively and surgically approaches. DATA SOURCES Pubmed, Scopus, and Web of Science databases were systematically screened. REVIEW METHODS The protocol of this investigation was registered on PROSPERO in April 2023 and the systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. RESULTS Both patients in the case studies showed a complete recovery within 2 to 3 months after the head trauma. One of them still reported a subjective taste alteration at last control. After the application of the inclusion-exclusion criteria, 9 manuscripts with adequate relevance to this topic were included in the systematic review. The study population consisted of 1971 patients with a diagnosis of posttraumatic facial nerve palsy, of which 128 with a dFNP. CONCLUSIONS dFNP due to head trauma is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated. Based on the reported data, it seems rational to propose a conservative approach for dFNP with steroid administration as a first line in most cases, indicating surgery in severe and/or refractory cases.
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Affiliation(s)
- Antonio Daloiso
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
| | - Tiziana Mondello
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Chiara Pavone
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Giacomo Spinato
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Enzo Emanuelli
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Diego Cazzador
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
| | - Elisabetta Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
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Sun P, Wang H, Jiang Z, Li L, Fan Z, Han Y. [Diagnosis and treatment of 68 cases of traumatic facial nerve paralysis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:405-410. [PMID: 38686478 DOI: 10.13201/j.issn.2096-7993.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 05/02/2024]
Abstract
Objective:To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Methods:Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. Results:The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases(38 ears), and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases(52 ears) , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases(50 ears) were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases(24 ears) of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved(P<0.05), and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment(P<0.05). There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes(P>0.05). The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse(P<0.05), but there was no significant difference between the facial nerve function after treatment(P>0.05). There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group(P>0.05). Conclusion:Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.
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Affiliation(s)
- Pengcheng Sun
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Zhen Jiang
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Li Li
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Zhaomin Fan
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Yuechen Han
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
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Abaturovas R, Jakstas T, Talijūnas A, Balseris S, Arechvo I. Cholesteatoma Complicated by Parapharyngeal Abscess That Occurred After Temporal Bone Fracture. Cureus 2024; 16:e57523. [PMID: 38707133 PMCID: PMC11066707 DOI: 10.7759/cureus.57523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Parapharyngeal abscess as a cervical complication of chronic otitis media with cholesteatoma is extremely rare. We present the case of a patient with chronic otitis media and cholesteatoma who developed a parapharyngeal abscess following a blunt head trauma. A 65-year-old man with a history of recurrent right purulent otorrhea presented with symptoms of profuse purulent otorrhea, headache, hoarseness, and difficulty swallowing. Imaging revealed the presence of a right parapharyngeal abscess alongside a temporal bone fracture, suggesting a potential direct spreading route of aggressive chronic suppurative otitis media infection through the bone fracture defects to the parapharyngeal space. The patient underwent abscess drainage via a transcervical approach with simultaneous emergency radical mastoidectomy. Despite the development of septic shock with acute renal failure in the postoperative period, the patient made a full recovery.
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Affiliation(s)
- Rokas Abaturovas
- Department of Otorhinolaryngology, Faculty of Medicine, Medical Academy, Vilnius University, Vilnius, LTU
| | - Tomas Jakstas
- Department of Otorhinolaryngology, Republican Vilnius University Hospital, Vilnius, LTU
| | - Andrius Talijūnas
- Center of Oral and Maxillofacial Surgery, Vilnius University Hospital Zalgiris Clinic, Vilnius, LTU
| | - Svajunas Balseris
- Department of Otorhinolaryngology, Republican Vilnius University Hospital, Vilnius, LTU
| | - Irina Arechvo
- Department of Otorhinolaryngology, Republican Vilnius University Hospital, Vilnius, LTU
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Poupore NS, Britt AF, Nguyen SA, White DR. Complications After Pediatric Temporal Bone Fractures by Classification System: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:1009-1019. [PMID: 38168743 DOI: 10.1002/ohn.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE 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. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS Per PRISMA guidelines, studies of children with TBFs were included. Meta-analyses of proportions were performed. RESULTS A total of 22 studies with 1376 TBFs were included. Children with TBF had higher rates of conductive hearing loss (CHL) than sensorineural hearing loss (SNHL) (31.3% [95% confidence interval [CI] 23.2-40.1] vs 12.9% [95% CI 8.9-17.5]). No differences in both CHL and 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] vs 4.9% [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] vs 8.6% [95% CI 5.2-12.8]), but rates were similar between OCS and OCV TBFs. CONCLUSION 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.
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Affiliation(s)
- Nicolas S Poupore
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Annie F Britt
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Medical University of South Carolina School of Medicine, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R White
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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5
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Maxwell AK, Kahane JB, Murphy TP. Audiologic Consequences of Gunshot Wounds to the Temporal Bone Show No Relation to Concomitant Neurologic or Vascular Injuries. Ann Otol Rhinol Laryngol 2024; 133:97-104. [PMID: 37497835 DOI: 10.1177/00034894231188574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES To evaluate audiologic consequences of gunshot wounds (GSWs) to the temporal bone (TB), and to correlate hearing outcomes with neurologic and vascular injuries adjacent to the temporal bone. STUDY DESIGN Retrospective case series. SETTING University-based level-one trauma center. METHODS Retrospective review of 35 patients surviving TB ballistic injury, 2012 to 2021. Main outcomes were audiologic results. Demographics, concomitant injuries, CT, and interventions were reviewed. RESULTS Mean age was 30.7 years; 80% male. Seventeen patients (48.6%) underwent audiologic testing. Mean pure tone average (PTA) was 75 ± 35 dB, bone line average 41 ± 26 dB, and speech discrimination score (SDS) 60 ± 43%. Nineteen (54.3%) demonstrated facial nerve injury (FNI), who were more likely to show SNHL especially anacusis, though their mean PTA and SDS were not statistically different from those without (P = .30 and .47, respectively). Radiographic review of those with sensorineural loss (SNHL, 6/17) revealed otic capsule-disrupting fracture (n = 2), pneumolabyrinth (n = 2), intracranial hemorrhage (n = 3). Those with mixed loss (6/17) showed otic capsule-sparing fracture (n = 6), EAC injury (n = 5), ossicular discontinuity (n = 2), and intracranial hemorrhage (n = 4). Two with mastoid tip fractures alone had normal audiograms. Audiometric outcomes were not predicted by concomitant CSF leak, spinal injuries, vascular injuries, cranial neuropathies, or traumatic brain injury. CONCLUSIONS All patterns of hearing loss-conductive, sensorineural, mixed and normal-may be seen following TB ballistic injuries. Trauma severe enough to disrupt the facial nerve is more likely to cause anacusis. However, all should be formally evaluated, since ballistic injuries complicated by neurologic or vascular damage do not necessarily correlate with worse audiologic outcomes, while patients with minimal fractures may demonstrate losses.
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Affiliation(s)
- Anne K Maxwell
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jacob B Kahane
- Department of Otolaryngology-Head and Neck Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Terrence P Murphy
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center- New Orleans, New Orleans, LA, USA
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Deshmukh KA, Fatima U, Siddiqui A, Tegnoor MS. Evaluation and Outcomes of Hearing Loss in Temporal Bone Fractures: A Prospective Study. Cureus 2023; 15:e46331. [PMID: 37916249 PMCID: PMC10618031 DOI: 10.7759/cureus.46331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/03/2023] Open
Abstract
Background Fractures of the skull base occur in 3-30% of head injury presentations to the emergency department. Overall, 9-40% of the cases have temporal bone fractures (TBFs). This fracture may disrupt the intervening structures causing edema, hematoma, bleeding, hearing loss, dizziness, cerebrospinal fluid otorrhea, and facial nerve paralysis. This study aims to evaluate the type of TBF, its correlation with hearing loss, and the outcomes of hearing loss. Methodology A prospective observational study was done among 50 patients who presented to the emergency department following trauma with clinical features and CT of the temporal bone suggestive of TBF. A complete evaluation of the patients was done, and patients were managed as per the departmental protocol. The patients were followed up for six months and monitored for otological symptoms. Periodic assessment of hearing loss by pure tone audiometry (PTA) was performed at the end of one week, one month, and six months. Results The most common type of fracture in our study was longitudinal TBF (72%), followed by transverse TBF (20%) and mixed TBF (8%). According to the newer classification, otic capsule-sparing fracture was more common than otic capsule-violating fracture. Most patients presented with conductive hearing loss (60%) following the TBF. On follow-up, there was a statistically significant improvement in hearing loss at the end of six months. Conclusions Our study found that in most cases hearing loss improved over time. Patients with conductive hearing loss showed maximum improvement in comparison to patients with sensorineural and mixed hearing loss.
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Affiliation(s)
- Kiran A Deshmukh
- Otolaryngology - Head and Neck Surgery, Mahadevappa Rampure Medical College, Kalaburgi, IND
| | - Uzra Fatima
- Otolaryngology - Head and Neck Surgery, Mahadevappa Rampure Medical College, Kalaburgi, IND
| | - Ayesha Siddiqui
- Otolaryngology - Head and Neck Surgery, Mahadevappa Rampure Medical College, Kalaburgi, IND
| | - Mallikarjun S Tegnoor
- Otolaryngology - Head and Neck Surgery, Mahadevappa Rampure Medical College, Kalaburgi, IND
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Yousef MF, Theyab R, Garadat SN, Hagr A. Bilateral Cochlear Implantations in Temporal Bone Fracture: A Viable Treatment Option. Laryngoscope 2021; 132:2050-2055. [PMID: 34932226 DOI: 10.1002/lary.29994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/23/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although it is surgically more challenging, patients with bilateral temporal bone fractures (TBFs) are potential candidates for successful bilateral cochlear implantation (CI). This study aimed to investigate the feasibility of bilateral implantation in patients with sustained bilateral TBFs. STUDY DESIGN Retrospective database study. METHODS Seven patients with bilateral cochlear implants who were diagnosed with TBFs were included in this study. Preoperative radiological and audiological evaluations were performed. The outcomes of the CI were also investigated. RESULTS Hearing levels were restored to the mild-moderate range (<40 dB) for nearly all patients and they reported an improved quality of life. CONCLUSIONS CI in patients with TBF is safe and offers a solution for the restoration of hearing in a population who may experience sudden bilateral deafness. However, preoperative confirmation of intact auditory nerves and patent cochlea is essential to maximize the success of CI in this population. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Medhat F Yousef
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Otolaryngology Department, College of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Rami Theyab
- Audiology Unit, Otolaryngology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Soha N Garadat
- Department of Hearing and Speech Sciences, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Radu RA, Terecoasa EO, Marinescu AN, Enache I, Tiu C. Cranial cerebrospinal fluid leak and intracranial hypotension syndrome - a case report. J Med Life 2021; 14:587-590. [PMID: 34621386 PMCID: PMC8485374 DOI: 10.25122/jml-2021-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
Spontaneous intracranial hypotension is a rare clinical entity caused in most cases by a cerebrospinal fluid leak occurring at the level of the spinal cord. Cranial dural leaks have been previously reported as a cause of orthostatic headaches but, as opposed to spinal dural leaks, were not associated with other findings characteristic of spontaneous intracranial hypotension. We present the case of a male admitted for severe orthostatic headache. The patient had a history of intermittent postural headaches, dizziness, and symptoms consistent with post-nasal drip, which appeared several years after head trauma. Brain imaging showed signs consistent with intracranial hypotension: bilateral hygromas, subarachnoid hemorrhage, superficial siderosis, diffuse contrast enhancement of the pachymeninges, and superior sagittal sinus engorgement. No spinal leak could be identified by magnetic resonance imaging, and the patient had a rapid remission of symptoms with conservative management. Further work-up identified an old temporal bone fracture which created a route of egress between the posterior fossa and the mastoid cells. Otorhinolaryngology examination showed pulsatile bloody discharge and liquorrhea at the level of the left pharyngeal opening of the Eustachian tube. The orthostatic character of the headache, as well as the brain imaging findings, were consistent with intracranial hypotension syndrome caused by a cranial dural leak. Clinical signs and imaging findings consistent with the diagnosis of apparently “spontaneous” intracranial hypotension should prompt the search for a cranial dural leak if a spinal leak is not identified.
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Affiliation(s)
- Razvan Alexandru Radu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Oana Terecoasa
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Andreea Nicoleta Marinescu
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Radiology and Medical Imaging, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Iulian Enache
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Cristina Tiu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Abrahão NM, Guimarães GC, Castilho AM, da Silva VAR. Bilateral facial paralysis secondary to temporal bone trauma: A case report and literature review. Clin Case Rep 2021; 9:e04272. [PMID: 34188929 PMCID: PMC8218326 DOI: 10.1002/ccr3.4272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
When temporal bone fractures are associated with facial palsy (FP) evolution the medical team have no much time to make a decision: to do or not to do a surgical approach? How to evaluate the necessity? When to do it and when is the correct time?
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Marszał J, Bartochowska A, Gawęcki W, Wierzbicka M. Efficacy of surgical treatment in patients with post-traumatic facial nerve palsy. Otolaryngol Pol 2021; 75:1-6. [PMID: 34344838 DOI: 10.5604/01.3001.0014.7446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The most common mechanism of post-traumatic facial nerve palsy are road accidents and falls. Treatment schemes as well as proper timing of surgery are still controversial. <br/><br/>Aim: The aim of the study was the evaluation of the effects of surgical treatment in patients with post-traumatic facial nerve palsy. Treatment results were correlated with epidemiological factors, mechanism of injury, level of nerve damage, time of surgery and its extent. <br/><br/>Material and methods: 9 patients with facial nerve palsy after head trauma were analyzed. In all patients complete paresis of the VII nerve occurred immediately after the injury. In 5 patients the nerve was damaged in the course of the longitudinal fracture of the temporal bone, in 3 as a result of its transverse fracture while in one woman there was no evident fracture line. In all cases, surgical treatment was performed between 4 days and 13 weeks after the trauma. In all cases transmastoid approach was used. Edema lesions of the nerve dominated in 6 patients, in two cases a bone fragment was noted along its course, in one person nerve was disrupted but primary reconstruction was not possible - the man was excluded from further analysis. The results of treatment were assessed by House-Brackmann (HB) scale 12 months after the procedure. <br/><br/>Results: Very good (HBI) or good (HBII) recovery of facial nerve function was achieved in 2 and 4 out of 8 patients respectively. Surgical timing, the extent of surgery, patient's age, mechanism of injury and level of nerve damage had no effect on the final outcome. <br/><br/>Conclusions: The management of post-traumatic facial nerve palsy should be individual. The commonly accepted recommendation on surgical treatment is to undertake it in patients with immediate-onset and complete paralysis. Patients who, due to their severe general condition, cannot undergo early facial nerve decompression may benefit from delayed treatment for up to 3 months after the injury.
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Affiliation(s)
- Joanna Marszał
- Department of Otolaryngology and Laryngological Oncology, Medical University of Poznan, Poland
| | - Anna Bartochowska
- Department of Otolaryngology and Laryngological Oncology, Medical University of Poznan, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Medical University of Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Medical University of Poznan, Poland
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Abstract
OBJECTIVE Ballistic injuries to the temporal bone are uncommon but devastating injuries that damage critical neurovascular structures. This review describes outcomes after ballistic injuries to the temporal bone and offers initiatives for standardized high-quality future research. DATA SOURCES A systematic search of PubMed, Embase, and Cochrane. REVIEW METHODS Studies in the review included adults who experienced temporal bone fractures due to gunshot wounds and survived longer than 48 hours. Individual case reports were excluded. The various searches returned 139 results, of which 6 met inclusion criteria. RESULTS Most of the included studies are case series with low-level evidence that report a wide range of outcomes and follow-up. Outcomes include demographic patient information, audiologic outcomes, vascular injuries, intracranial complications, facial nerve function, and surgical indications. CONCLUSION This review is the first to characterize the nature and progression of patients who experienced gunshot wounds to the temporal bone. Although all patients share an etiology of injury, they often have vastly different hospital courses and outcomes. This review provides a basis for future studies to guide care for these injuries, as most of the existing literature includes small dated case series.
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Affiliation(s)
- Kenneth L Kennedy
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
| | - Jessica Petrey
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
| | - Jerry W Lin
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, USA
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Andresen NS, Zhu V, Lee A, Sebetka W, Kimura J, Hansen MR, Gantz BJ, Sun DQ. Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods. Laryngoscope Investig Otolaryngol 2020; 5:928-935. [PMID: 33134541 PMCID: PMC7585247 DOI: 10.1002/lio2.458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/17/2020] [Accepted: 08/30/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To study the relationship between various electrodiagnostic modalities in acute facial palsy. SETTING Academic tertiary care center. PATIENTS One-hundred and six patients who presented with traumatic or non-traumatic acute facial paralysis (House-Brackmann, HB, grade 6/6) between 2008 and 2017 and underwent acute electrodiagnostic testing. INTERVENTION Electroneurography (ENoG) using nasolabial fold (NLF) or nasalis muscle (NM) methods, and volitional electromyography (EMG) in all patients. MAIN OUTCOME MEASURES Percent degeneration of ipsilateral facial nerve compound muscle action potentials (CMAP) on NLF- and NM-ENoG, presence or absence of muscle unit potentials (MUPs) on EMG. RESULTS Extent of facial nerve degeneration measured by NLF- and NM-ENoG were highly correlated (r = 0.85, P < .01) on each test and on serial testing. NLF- and NM-ENoG concordantly diagnosed ≥90% degeneration in 44 patients (80%), of whom 32 patients were diagnosed to have 100% degeneration by both methodologies. Absence of MUPs on EMG was 63% sensitive and 92% specific for ≥90% degeneration on ENoG, with a positive predictive value of 90%. For patients with Bell's palsy, percent degeneration on ENoG was also correlated to HB score at 1 year. Surgical decompression resulted in mean HB scores of 2.2 and 3.0 for patients with Bell's palsy and trauma, respectively. CONCLUSIONS NM-ENoG may be a valid and comparable method to NLF-ENoG for predicting the recovery of facial nerve function in acute paralysis. Absence of MUPs on EMG is a specific measure of severe degeneration and highly predictive of candidacy for surgical decompression. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Nicholas S. Andresen
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Vivian Zhu
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Andrew Lee
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Wendy Sebetka
- Department of NeurologyUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Jun Kimura
- Department of NeurologyUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Marlan R. Hansen
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
- Department of NeurosurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Bruce J. Gantz
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
- Department of NeurosurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Daniel Q. Sun
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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13
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Lubner RJ, Knoll RM, Trakimas DR, Bartholomew RA, Lee DJ, Walters B, Nadol JB, Remenschneider AK, Kozin ED. Long-term cochlear implantation outcomes in patients following head injury. Laryngoscope Investig Otolaryngol 2020; 5:485-496. [PMID: 32596492 PMCID: PMC7314488 DOI: 10.1002/lio2.378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/27/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE In cases of a severe to profound sensorineural hearing loss following head injury, the cochlear implant (CI) is the primary option for auditory rehabilitation. Few studies, however, have investigated long-term CI outcomes in patients following head trauma, including those without temporal bone fracture (TBF). Herein, the aim of this study is to examine CI outcomes following cases of head injury with and without TBF. METHODS Audiometric outcomes of patients who received a CI due to a head injury resulting in severe to profound hearing loss at two tertiary care hospitals were analyzed. Patients were divided into those who received a CI in a fractured temporal bone (group A, n = 11 patients corresponding to 15 ears) and those who received a CI in a non-fractured temporal bone (group B, n = 8 patients corresponding to nine ears). Primary outcomes included duration of deafness prior to CI and postoperative consonant-nucleus-constant whole word (CNC) scores. RESULTS Nineteen patients (84% male), corresponding to 24 CIs, were identified. Fifteen CI were performed on ears with TBF (group A), and nine CI were performed on ears without TBF (group B). No patients had an enlarged vestibular aqueduct (EVA). The mean duration of deafness was 5.7 and 11.3 years in group A and group B, respectively. The mean duration of CI follow-up (CI experience) was 6.5 years in group A and 2.1 years in group B. The overall mean postoperative CNC score for all subjects was 68.6% (±21.2%, n = 19 with CNC testing). There was no difference in CNC score between group A and group B (69.8% and 66% respectively, P = .639). CONCLUSION The study is among the largest series examining long-term outcomes of CI after head injury. CI is an effective method for auditory rehabilitation in patients after head injury. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Rory J. Lubner
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Renata M. Knoll
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Danielle R. Trakimas
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyJohns Hopkins Medical SchoolBaltimoreMDUSA
| | - Ryan A. Bartholomew
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Daniel J. Lee
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Brad Walters
- Department of OtolaryngologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Joseph B. Nadol
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Aaron K. Remenschneider
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical CenterWorcesterMassachusettsUSA
| | - Elliott D. Kozin
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
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14
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Bächinger D, Goosmann MM, Schuknecht B, Nadol JB, Adams JC, Huber A, Eckhard AH. Clinical Imaging Findings of Vestibular Aqueduct Trauma in a Patient With Posttraumatic Meniere's Syndrome. Front Neurol 2019; 10:431. [PMID: 31073295 PMCID: PMC6495004 DOI: 10.3389/fneur.2019.00431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022] Open
Abstract
Posttraumatic Meniere's syndrome is a rare clinical entity. The pathomechanism by which temporal bone trauma leads to fluctuating audiovestibular symptoms, in some cases with a delay of onset many years after trauma, remains elusive. Here, a clinical case and the respective temporal bone imaging data were reviewed to investigate the underlying inner ear pathology. A 44-year-old patient presented with left-sided Meniere's syndrome 34 years after he suffered an ipsilateral temporal bone fracture caused by a car accident. Clinical imaging showed left cochleovestibular hydrops (gadolinium-enhanced MRI) and bony obliteration of the left VA (CT imaging), resulting in discontinuity of the ES. Our findings suggest that a temporal bone fracture with a “retrolabyrinthine” course, traversing the VA, caused intraaqueductal callus bone formation and progressive blockage of the VA. As a result, the extraosseous (distal) endolymphatic sac (eES) became separated from the cochleovestibular labyrinth, an event that presumably underlies endolymphatic hydrops formation and that precipitates the onset of clinical Meniere's symptoms in this case.
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Affiliation(s)
- David Bächinger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | | | | | - Joseph B Nadol
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States.,Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Joe C Adams
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States.,Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Alexander Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Andreas H Eckhard
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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15
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Abbaszadeh-Kasbi A, Kouhi A, Ashtiani MTK, Anari MR, Yazdi AK, Emami H. Conservative versus Surgical Therapy in Managing Patients with Facial Nerve Palsy Due to the Temporal Bone Fracture. Craniomaxillofac Trauma Reconstr 2018; 12:20-26. [PMID: 30815211 DOI: 10.1055/s-0038-1625966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022] Open
Abstract
Facial nerve paralysis is classified into immediate or delayed-onset palsy, and affected patients should be treated through conservative or surgical therapy. Appropriate treatment is somewhat debated as well as proper time for performing surgery. This study aimed to assess treatment outcome between conservatively and surgically treated groups and to determine the appropriate time of surgery in selected patients for surgery. Twenty-four patients from April 2008 to July 2015 were included. Performing decompression surgery within the first 2 months following the trauma accompanies a better prognosis ( p -value < 0.05). Eleven patients were managed conservatively, and 4 of them demonstrated immediate onset and 7 indicated delayed onset. Nine patients obtained normal nerve function, one patient had partial palsy, and one of them had complete palsy. There was no significant difference in the rate of recovery between types of the treatment ( p -value > 0.05). Decompression surgery is recommended in the first 2 months after the trauma for immediate onset and also complete degeneration on electroneuronography.
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Affiliation(s)
| | - Ali Kouhi
- Otolaryngology Research Center, Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahtab Rabbani Anari
- Otolaryngology Research Center, Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Karimi Yazdi
- Otolaryngology Research Center, Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Emami
- Otolaryngology Research Center, Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran
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16
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Abstract
Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted.
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Affiliation(s)
- Rodney C Diaz
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Hilary A Brodie
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, United States
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17
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Kanavati S, Salamat AA, Tan TY, Hellier W. Bilateral temporal bone fractures associated with bilateral profound sensorineural hearing loss. Postgrad Med J 2016; 92:302-3. [PMID: 26719451 DOI: 10.1136/postgradmedj-2015-133862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/02/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Sam Kanavati
- ENT Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ali A Salamat
- ENT Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK Academic Unit of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Ting Yang Tan
- Department of Trauma & Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - William Hellier
- ENT Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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18
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Abstract
OBJECTIVE To characterize pediatric temporal bone trauma, focusing on audiometric outcomes. STUDY DESIGN Case series with chart review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS Cases were reviewed of children (<18 years) presenting over a 3-year period with computed tomography-proven temporal bone fracture and audiology examination. All scans were read by a neuroradiologist and reviewed by a pediatric otolaryngologist. Demographics, fracture pattern, and audiometric data were recorded. RESULTS Fifty-eight patients (60 fractures) met inclusion criteria. The majority (93%) were otic capsule-sparing fractures. The types and severity of hearing loss were significantly different between the 2 fracture patterns. Based on pure-tone average, all otic capsule-violating fractures had abnormal initial audiograms; 75% of these losses were severe. Approximately half (54%) of otic capsule-sparing fractures had abnormal initial audiograms; a majority were mild losses (85%). All classifiable losses in otic capsule-violating cases were of mixed type, whereas the majority (75%) of losses in otic capsule-sparing cases were conductive. Regardless of classification, 72% of patients with otic capsule-sparing fractures and initially abnormal audiograms improved to normal levels at a mean of 48 days posttrauma; this increased to 83% when only conductive losses were considered. CONCLUSIONS Hearing loss type and severity differ in otic capsule-sparing and otic capsule-violating temporal bone fractures. A majority of children with otic capsule-sparing fractures and associated hearing loss improve to normal levels in about 6 weeks, especially if the original loss is classified as solely conductive. Children who do not improve within this time frame may warrant early investigation into surgically correctable causes.
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Affiliation(s)
- Amy Schell
- UPMC Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Dennis Kitsko
- UPMC Department of Otolaryngology, Pittsburgh, Pennsylvania, USA Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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