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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 762-765

Computed tomography evaluation of temporal bone fracture and hearing loss: A narrative review with systematic analysis


1 Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
2 Department of Dermatology, Venereology and Leprosy, Ram Manohar Lohia Hospital, Lucknow, Uttar Pradesh, India

Date of Submission09-Nov-2021
Date of Decision23-Jun-2022
Date of Acceptance15-Aug-2022
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Prerna Anup Patwa
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_415_21

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  Abstract 


In the modern world, the most common cause of head trauma causing temporal bone fracture in adults is road traffic accidents with high impact force. Hearing loss is one of the most common complaints after head trauma involving temporal bone fracture. Because of other life-threatening conditions associated with road traffic accidents, fractures of temporal bone is often overlooked. If these fractures are detected early, there complications can be avoided with conservative or surgical intervention. In this research following databases were used to search for published as well as unpublished studies over the period 2000–2021 in the English language: PubMed, EMBASE, and Web of Science. The terms used to generate a search were as follows: Temporal bone fracture and hearing loss. Those studies which did not fulfil the inclusion criteria were removed. Case reports, documentaries, and duplicate data were excluded. Most common cause of injury leading to temporal bone fracture was road traffic accident. Majority of cases were males belonging to the age group of 31–40 years and average age was 36 years. According to traditional classification, majority had longitudinal fracture followed by transverse fracture. According to newer classification, otic capsule sparing was more common in comparison to otic capsule involvement. The conductive type of hearing loss was more common and it was found associated with longitudinal fracture while sensorineural type of hearing loss was associated with transverse type of fracture. The conductive type of hearing loss was usually common in otic capsule sparing while sensorineural type of hearing loss is associated with otic capsule involvement. Otic capsule sparing is mostly seen in longitudinal fracture and transverse fracture involves otic capsule involvement. Head trauma due to fast moving vehicles is the most common cause of injury leading to temporal bone fracture. Because of complex structure of temporal bone identification of line of fracture is necessary which requires high-resolution computed tomography (CT) of the head. High-resolution CT not only helps in knowing anatomy and types of fracture but also it helps in knowing sequelae of various types of fractures which helps in treating physician weather to go for conservative or surgical intervention.

Keywords: Computed tomography temporal bone, hearing loss, longitudinal fracture, pure tone audiometry, transverse fracture


How to cite this article:
Singh RK, Mishra GV, Dhande RP, Patwa PA, Singh S. Computed tomography evaluation of temporal bone fracture and hearing loss: A narrative review with systematic analysis. J Datta Meghe Inst Med Sci Univ 2022;17:762-5

How to cite this URL:
Singh RK, Mishra GV, Dhande RP, Patwa PA, Singh S. Computed tomography evaluation of temporal bone fracture and hearing loss: A narrative review with systematic analysis. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 4];17:762-5. Available from: http://www.journaldmims.com/text.asp?2022/17/3/762/360221




  Introduction Top


One of the most common causes of mortality in population all over the world is trauma to head due to fast moving vehicles. In road traffic accidents, injuries can be simple like only laceration of pinna or it can be complex such as fractures of temporal bone. These fractures can lead to hearing loss or facial nerve paralysis. According to traditional classification, temporal bone fractures are classified as longitudinal, transverse, and mixed/oblique fracture. According to new classification, they are classified as otic capsule sparing or otic capsule involvement type. Direct impact to temporoparietal region results in longitudinal type of fracture while direct impact to occipital region results in transverse fracture. There are high chances of sensorineural hearing loss due to very high impact force leading to penetrating injury. The traditional classification system of temporal bone fracture is based on the relationship of fracture line with the petrous pyramid.[1] Other causes of injury leading to temporal bone fracture apart from road traffic accidents are fall from height, occupational injury, and assault.[2] If we consider globally after HIV and depression, third most common burden of disease is road traffic accident.[3] Renal tubular acidosis (RTA) usually involves the younger and the middle age group with a male preponderance in epidemiology and hence adversely affects the economic growth of that country. This is especially true in middle-income countries such as India.[4] Even though India has only 1% of worlds vehicles, it accounts for 6% of worlds road traffic accidents because of general disregard for traffic rules and lack of proper infrastructure.[5] One of the most common complain after temporal bone fracture is hearing loss. Because of other life-threatening conditions associated with road traffic accidents, fractures of temporal bone are often overlooked. This is the reason why we have only limited studies on hearing loss and temporal bone fractures. If these fractures are detected early, there complications can be avoided with conservative or surgical intervention. In India, studies regarding the actual burden of hearing loss secondary to temporal bone fractures are scant. In a study conducted by Kumar et al.[6] on the mortality and morbidity associated with RTA, it was found that skull fracture was present in 69.63% cases. Most common fracture being that of temporal bone, found in 47.25% of cases. Hence, this research was undertaken to estimate the burden of hearing loss associated with temporal bone fractures. This research is done to evaluate the various otological manifestations in head injury and its sequel.

Due to rise of polytrauma cases, there is increase in cases of temporal bone fracture. Even though during initial examination of patients injury to temporal bone often overlooked which can result in grievous injuries. In order to have better outcome of patients health injuries to facial nerve and vestibular nerve should be identified as they can lead to facial nerve palsy and sensorineural hearing loss. For conservative management usually, steroids are given which helps in improvement of facial nerve palsy and sensorineural hearing loss.

Inclusion criteria

  1. All patients having temporal bone fractures as evaluated by high-resolution computed tomography (CT) were included in the study.


Exclusion criteria

  1. Patients having active or old pathological conditions of the ear
  2. Patients having injury to brain parenchyma including brainstem
  3. Patients not able to follow-up
  4. Case reports, commentaries, and duplicate data were excluded.



  Methodology Top


In this research, following databases were used to search for published as well as unpublished studies over the period 2000–2021 in the English language: PubMed, EMBASE, and Web of Science. Terms used to generate a search were as follows: Temporal bone fracture, hearing loss. Those studies which did not fulfil the inclusion criteria were removed. Case reports, documentaries and duplicate data were excluded. Thirteen studies were thus included.


  Results Top


A total of 13 articles were considered for the evaluation of hearing loss associated with temporal bone fracture on CT. These studies were done between year of 2000 and 2021. A total of 1082 cases were studied. Out of these cases, male patients were more than female patients. The average age was 30–40 years.

The study characteristics are listed in [Table 1].
Table 1: Characteristics of the studies

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The additional study characteristics are listed in [Table 2].
Table 2: Additional characteristics of the studies

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The research primary goal was to find out major cause of temporal bone fracture, types of fractures based on traditional and new classification, types of hearing loss, any association between hearing loss and temporal fracture based on traditional and new classification. Mehmet Yilmaz Alposy et al.,[12] (2021) According to their study, 78.5% of cases had road traffic accidents. 300 cases had temporal bone fractures with an average age of 32.9 years. Majority of cases were males. Longitudinal fracture was the most common type with the majority of cases having sensorineural type hearing loss.

Padmakumar et al.,[8] (2019). In their study road traffic accidents accounted for 66.7% and 90 cases had temporal bone fracture as evaluated on CT. Most were 76 males. Average age was 34.3 years 76.7% had longitudinal fracture followed by transverse. Out of 56 with hearing loss 53.3% had conductive hearing loss and only 14% had otic capsule involvement.

Umamaheshwari Basavaraju et al.,[9] (2017). In their study the most common cause of injury was road traffic accidents accounting for 84.48%. Total cases with temporal bone fracture were 154 with an average age 37.1 years. Most were 102 males. Majority had 36 (56.2%) longitudinal fracture followed by 20 (31.25%) mixed fracture. 5 cases had hearing loss on pure tone audiometry and 41 (64.1%) had otic capsule sparing.

Maradi et al.,[11] (2017) According to their study road traffic accidents was most common cause of injury. Out of 45 cases of temporal bone fracture 33 were males. 73.3% had longitudinal fracture followed by mixed type. Conductive hearing loss was noted in 75.6% cases followed by mixed hearing loss. Otic capsule involvement was noted in 10% cases while the majority had 77.7% otic capsule sparing.

Parmar et al.,[12] (2015) In their study road traffic accidents accounted for 55% and the most common type of hearing loss was conductive type. Majority of cases had longitudinal fracture. According to their study sensorineural hearing loss was associated with transverse fracture and conductive hearing loss with longitudinal fracture.

Wood et al.,[13] (2014) In their study road traffic accidents was the most common cause of injury with 39 cases of temporal bone fracture. Average age was 41.3 years with the majority of cases being 33 males. However 56.5% cases had transverse fracture followed by 39.1% longitudinal fracture. Only 9% cases had otic capsule involvement.

Cvorovic Ljiljana et al.,[15] (2012). According to their study 53% had falls as the most common cause of injury. 50% cases had longitudinal fracture followed by mixed type. 21 cases had hearing loss of which 16 were having conductive type hearing loss.

Gurbax Singh et al.,[14] (2011) In their study 64% cases had road traffic accidents as the most common cause. 9 cases had temporal bone fracture with an average age group of 21–30 years. 78% had longitudinal fracture followed by transverse fracture. Majority had mixed hearing loss followed by conductive hearing loss.

Kang et al.,[16] (2011) In their study 31% of cases had road traffic accidents. 129 cases had temporal bone fracture with an average age of 44.2 years. 105 were males and 24 were females. 75.2% cases had longitudinal fracture. 78 cases had hearing loss with 45 (57.7%) cases having conductive hearing loss followed by 33.3% of sensorineural hearing loss. Otic capsule involvement was noted in 11 (8.5%) cases.

Amin et al.,[17] (2008) In their study 85.9% cases had road traffic accidents as the most common cause. They studied 61 cases of temporal bone fracture of which majority were 54 males. 67.4% cases had longitudinal type of fracture. 6 cases had hearing loss with equal weightage to both conductive and mixed hearing loss. 100% cases had otic capsule sparing.

Little et al.,[18] (2006) In their study 47% cases had road traffic accident with 30 cases with temporal bone fracture as evaluated on CT. 50% had longitudinal fracture followed by transverse fracture. 11 cases had conductive hearing loss and only 6 cases (20%) had otic capsule involvement.

Kahn et al.,[19] (2000) In their study the total number of cases with temporal bone fracture were 105 and the most common cause of injury was road traffic accidents. Average age was 27.1 years. Majority were 75 males. Longitudinal fracture was most common accounting for 43 cases. 59 cases had hearing loss of which 56% had conductive hearing loss.


  Discussion Top


Most common cause of temporal bone fracture was road traffic accidents followed by fall from height. Majority of cases were males with most of them belonging to the age group of 31–40 years and average age was 36 years. Right side was more involved and otorrhea was the most common clinical presentation. According to traditional classification, the majority had longitudinal fracture followed by transverse fracture. According to newer classification otic capsule sparing was more common in comparison to otic capsule involvement. Tinnitus was the most common symptom followed by vertigo. Majority had a conductive type of hearing loss followed by mixed hearing loss. It was found that conductive type of hearing loss is associated with longitudinal fracture and sensorineural hearing loss is associated with transverse fracture. Otic capsule sparing is associated with conductive hearing loss and sensorineural hearing loss is associated with otic capsule involvement. Otic capsule sparing is mostly seen in longitudinal fracture and transverse fracture involves otic capsule involvement.


  Conclusion Top


Head trauma is the most common cause of temporal bone fracture and the most common cause of injury is road traffic accidents. Because of the complex structure of temporal bone identification of the line of fracture is necessary which requires high resolution CT of the head. Longitudinal fractures are more common than transverse fracture and conductive type of hearing loss is often associated with longitudinal fracture and sensorineural type is more common with transverse fracture. Usually conservative treatment is sufficient for temporal fracture but sometimes complicated cases requires surgical intervention. High resolution CT not only helps in knowing anatomy and types of fracture but also it helps in knowing sequelae of various types of fractures which helps in treating physician weather to go for conservative or surgical intervention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gurdjian ES, Lissner HR. Deformation of the skull in head injury studied by “stresscoat” technique: Quantitative determinations. Surg Gynecol Obstet 1946;83:219-33.  Back to cited text no. 1
    
2.
Peden M, Scurfield R, Sleet D, Mathers C, Jarawan E, Hyder AA, et al. World Report on RTI Prevention. Geneva: WHO; 2004.  Back to cited text no. 2
    
3.
Mathers CD, Bernard C, Iburg KM, Inoue M, Ma Fat D, Shibuya K, et al. Global Burden of Disease in 2002: Data Sources, Methods and Results. Geneva: World Health Organization; 2003. p. 54.  Back to cited text no. 3
    
4.
World Health Organization. The Global Burden of Disease: 2004 Update. World Health Organization; 2008.  Back to cited text no. 4
    
5.
Williams WT, Ghorayeb BY, Yeakley JW. Pediatric temporal bone fractures. Laryngoscope 1992;102:600-3.  Back to cited text no. 5
    
6.
Kumar A, Lalwani S, Agrawal D, Rautji R, Dogra TD. Fatal road traffic accidents and their relationship with head injuries: An epidemiological survey of five years. Indian J Neurotrauma 2008;5:63-7.  Back to cited text no. 6
    
7.
Parmar VS, Golhar SV, Deshmukh P, Pathania P. General ENT evaluation in head injury cases with special reference to temporal bone injury. J Evol Med Dent Sci 2015;4:5218-21.  Back to cited text no. 7
    
8.
Francis VD. A Study on Hearing Impairment in Patients with Fracture Temporal Bone; 2021. Available from: http://Worldwidejournals.com. [Last accessed on 2021 Nov 09].  Back to cited text no. 8
    
9.
Basavaraju U, Jayaramaiah SK, Turamari RU, Prakash V, Mankani S. Temporal bone fractures and its classification: Retrospective study of incidence, causes, clinical features, complications and outcome. Int J Anat Radiol Surg 2017;6:RO57-61.  Back to cited text no. 9
    
10.
Maradi N, Somanath BM. Hearing loss following temporal bone fractures – A study on classification of fractures and the prognosis. Int J Otorhinolaryngol Head Neck Surg 2017;3:390.  Back to cited text no. 10
    
11.
Padmakumar V, Ramesh Kumar E, Ramakrishnan VR. A prospective study on temporal bone involvement in polytrauma patients and the effect of early diagnosis on hearing loss. Indian J Otolaryngol Head Neck Surg 2020;72:30-5.  Back to cited text no. 11
    
12.
Alpsoy MY, Sönmez S, Orhan Z, Kocasoy Orhan E, Aslıyüksek H, Orhan KS. Evaluation of patients with post-traumatic hearing loss: A retrospective review of 506 cases. J Int Adv Otol 2021;17:239-44.  Back to cited text no. 12
    
13.
Wood CP, Hunt CH, Bergen DC, Carlson ML, Diehn FE, Schwartz KM, et al. Tympanic plate fractures in temporal bone trauma: Prevalence and associated injuries. AJNR Am J Neuroradiol 2014;35:186-90.  Back to cited text no. 13
    
14.
Singh G, Singh B, Singh D. Prospective study of 'otological injury secondary to head trauma'. Indian J Otolaryngol Head Neck Surg 2013;65:498-504.  Back to cited text no. 14
    
15.
Cvorovic L, Jovanovic MB, Markovic M, Milutinovic Z, Strbac M. Management of complication from temporal bone fractures. Eur Arch Otorhinolaryngol 2012;269:399-403.  Back to cited text no. 15
    
16.
Kang HM, Kim MG, Boo SH, Kim KH, Yeo EK, Lee SK, et al. Comparison of the clinical relevance of traditional and new classification systems of temporal bone fractures. Eur Arch Otorhinolaryngol 2012;269:1893-9.  Back to cited text no. 16
    
17.
Amin Z, Sayuti R, Kahairi A, Islah W, Ahmad R. Head injury with temporal bone fracture: One year review of case incidence, causes, clinical features and outcome. Med J Malaysia 2008;63:373-6.  Back to cited text no. 17
    
18.
Little SC, Kesser BW. Radiographic classification of temporal bone fractures: Clinical predictability using a new system. Arch Otolaryngol Head Neck Surg 2006;132:1300-4.  Back to cited text no. 18
    
19.
Kahn JB, Stewart MG, Diaz-Marchan PJ. Acute temporal bone trauma: Utility of high-resolution computed tomography. Otol Neurotol 2000;21:743-52.  Back to cited text no. 19
    



 
 
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