Audiometric Outcomes in Pediatric Temporal Bone Trauma

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.