Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (1): 13-19.doi: 10.6040/j.issn.1673-3770.0.2021.436

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Clinical characteristics and management of pediatric temporal bone fractures

MA Ning1,2, CHEN Min1,2, LIU Wei1,2, YANG Yang1,2, SHAO Jianbo1,2, HAO Jinsheng1,2, LIU Bing1,2, ZHANG Xiao1,2, DUAN Xiaomin3, ZHANG Qifeng3, ZHANG Jie1,2   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China;
    2. Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing 100045, China;
    3. Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
  • Online:2022-01-10 Published:2022-02-22

Abstract: Objective To summarize the clinical characteristics and treatment strategies of temporal bone fracture in children. Methods Medical records of 477 children under 18 years old who were diagnosed with temporal bone fracture in Beijing Children's Hospital from July 2014 to July 2021 were retrospectively analyzed. Including age, gender, injury causes, imaging, facial nerve and audiological assessment, complications, treatment and prognosis. Results 483 sides of 477 children,6 of which were bilateral. The age range was from birth to 18 years old, the median age was 9 years old, and the male to female ratio was 3.01∶1. Traffic accidents were the main cause of injuries, accounting for 57.23%, followed by falls, accounting for 23.69%. The most common clinical symptoms are tympanema and ear hemorrhage, which usually disappear from 3 weeks to 1 month. Longitudinal fracture accounted for 52.38%, transverse fracture 35, 7.25%; 48 cases of mixed fracture, accounting for 9.93%, and 147 cases, accounting for 30.43%, which could not be classified, were presented as minor fracture lines.372 cases(77.02%)had hearing impairment. Facial nerve injury occurred in 28 cases(5.80%), including 8 cases of internal auditory canal injury. Cerebrospinal fluid otorrhea(CSF)was found in 47 cases(9.73%). Tympanic membrane perforation occurred in 15 cases(3.11%). 6.35% with intracranial injury. 3.98% complicated with multiple fractures or multiple organ injuries. There were 10 cases of immediate facial paralysis, 1 case recovered well, accounting for 10.00%, and 18 cases of delayed facial paralysis, 15 cases recovered well, accounting for 83.33%. 10 cases were treated by operation, including 8 cases of tympanum exploration and ossicular chain reconstruction. Facial nerve HB Ⅴ was recovered to HB Ⅱafter decompression in 2 cases. Conclusion Temporal bone fracture in children is most common in boys, and the most common cause of injury is traffic accident. Tympanic hemorrhage, tympanic membrane perforation, cerebrospinal fluid otorrhea and conductive deafness can be cured by conservative treatment. Trauma caused ossicular chain fracture or dislocation has a good prognosis by surgical treatment. Trauma caused internal auditory canal fracture can cause extremely severe sensorineural deafness and complete facial paralysis with poor prognosis.

Key words: Temporal bone fracture, Pediatric, Facial nerve injury, hearing loss, Cerebrospinal fluid leak

CLC Number: 

  • R764.3
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[1] HU Chunyan, DANG Panhong, ZHANG Rui, FAN Mengyun. Analysis of audiological and imaging characteristics of 149 children with unilateral sensorineural hearing loss [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 31-36.
[2] DANG Panhong, ZHANG Rui, HU Chunyan, WANG Jie, FAN Mengyun. Clinical analysis of facial nerve decompression via an external transmastoid-subtemporal labyrinth approach in eight children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 37-42.
[3] LONG Ting, LIU Yuwei, WANG Shengcai, ZHANG Jie, LI Yanzhen, ZHANG Xuexi, LIU Qiaoyin, LIU Zhiyong, SUN Nian, NI Xin. A clinical analysis on children with congenital pyriform sinus fistula treated through microscopic laryngoscopy with CO2 laser cauterization [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 125-130.
[4] PAN Linlin, KONG LingyiOverview,ZHAI Feng, CHEN JieGuidance. Research progress on auditory risk factors and hearing screening methods among neonates [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 131-137.
[5] ZHOU Lamei, JIANG Wen, LIU Wen, QIAO Yuehua. Analysis of factors related to the severity of persistent idiopathic tinnitus [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 70-76.
[6] ZHONG Liping, GUAN Xilong, WANG Jingjing, TANG Yong. Intratympanic injections and systemic glucocorticoid treatment for sudden hearing loss: a systematic review and Meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 1-10.
[7] WU ZebinOverview,QIU QianhuiGuidance. Endoscopic surgery for skull base lesions in pediatric patients [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 112-117.
[8] TAN Yufang, YI Tianhua. Clinical characteristics and prognosis of sudden sensorineural hearing loss in post-irradiated nasopharyngeal carcinoma survivors: a report of 18 cases [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 35-39.
[9] CHEN Kun,LI Lei, MENG Guozhen, YANG Jun, HOU Dongming. Nasal chondromesenchymal hamartoma in infants: A report of two cases and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 27-30.
[10] To analyze the clinical outcomes of patients with unilateral idiopathic sudden sensorineural hearing loss(SSNHL)and explore the relationship between vestibular function and prognosis in patients with SSNHL. MethodsA retrospective analysis of patients( ears)with SSNHL was performed. A total of vestibular function tests were performed in all patients to assess the influence of vestibular functions on the clinical outcome of SSNHL. ResultsTreatments were less effective in patients with abnormalities in ocular vestibular evoked myogenic potential(oVEMP)or cervical vestibular evoked myogenic potential(cVEMP). Those with normal oVEMP and cVEMP had relatively better hearing recovery. The outcomes of the caloric test or video head impulse test showed no association with the efficacy of treatment or hearing recovery in patients with SSNHL. Treatment was less effective in patients with abnormalities in both oVEMP and cVEMP, who also had worse hearing recovery than those who had an abnormal finding in only one of the two tests. ConclusionsPatients with abnormal oVEMP or cVEMP results had poor clinical outcomes, while those with normal oVEMP and cVEMP demonstrated better hearing recovery with treatment. Thus, oVEMP and cVEMP could be effective indices to predict the prognosis of patients with SSNHL. An abnormal vestibular function is a definite indicator of a wider and more severe pathological change in the inner ear of patients with SSNHL.. Clinical value of vestibular evoked myogenic potential to predict prognosis of unilateral idiopathic sudden sensorineural hearing loss [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 27-32.
[11] To analyze the relationship between vestibular symptoms and function and hearing outcomes in patients with unilateral profound sudden sensorineural hearing loss(SSNHL). MethodsA retrospective analysis of patients with unilateral profound SSNHL was performed. Vestibular symptoms and the results of ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoked myogenic potential(cVEMP), video head impulse test(vHIT), and caloric test were analyzed to observe the relationship between hearing outcomes and vestibular symptoms and function. ResultsOf patients with unilateral profound SSNHL, there was a significant difference between the patients with and without vestibular symptoms, patients with vestibular dysfunction, and those with normal vestibular function. Patients with abnormal oVEMP, cVEMP, vHIT, and caloric test results showed a lower total effective rate. In contrast, patients with normal results in all four tests had a higher hearing recovery. ConclusionPatients with unilateral profound SSNHL with abnormal vestibular dysfunction and symptoms had a poor curative effect. Conversely, those with normal oVEMP, cVEMP, vHIT, and caloric test results had better chances of hearing recovery. Abnormal vestibular function suggests more extensive and severe inner ear lesions in patients with unilateral profound SSNHL.. Relationship between prognosis and vestibular symptoms/function in patients with unilateral profound sudden sensorineural hearing loss: A retrospective analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 33-38.
[12] To determine the therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease.MethodsClinical data of patients with unilateral intractable Menieres disease who underwent retrolabyrinthine vestibular neurectomy were retrospectively investigated. Therapeutic effectiveness was analyzed, and the safety and reliability of the procedure was discussed. ResultsThe mean duration of the disease was .±. months. Preoperative pure tone average of Hz, Hz, Hz, and Hz was(.±.)dB HL. Two cases were stage Ⅱ, cases were stage Ⅲ, and cases were stage Ⅳ. Two stage Ⅱ patients were recurrent cases after endolymphatic sac decompression surgery. Intracranial infection in case(.%), cerebrospinal fluid leakage in cases(.%), temporal facial nerve palsy in case(.%), incision infection in cases(.%), and fat liquefaction in cases(.%)were observed postoperatively. There was no case of intracranial hemorrhage or total deafness. Therapeutic effectiveness for relieving vertigo was level A in cases and level B in cases. ConclusionThe therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease is definite. Surgical risk and postoperative complications are controllable, and the quality of life can be significantly improved after surgery.. Therapeutic effectiveness of 75 cases of retrolabyrinthine vestibular neurectomy for intractable Menieres disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 46-50.
[13] Sudden sensorineural hearing loss(SSNHL)is defined as a decease in hearing ≥30 dB HL affecting at least three consecutive frequencies with no identifiable cause within 72 h. A possible cause is inner ear hemorrhage. However, detecting inner ear hemorrhage is difficult with conventional magnetic resonance imaging(MRI)sequences. Some studies showed that the 3-dimensional fluid attenuated inversion recovery(3D-FLAIR)MRI sequence could sensitively detect inner ear hemorrhage in SSNHL patients. In this article, we review the related literature about the clinical application of the 3D-FLAIR MRI sequence to evaluate SSNHL caused by inner ear hemorrhage.. The role of three-dimensional fluid attenuated inversion recovery magnetic resonance imaging in diagnosis of sudden sensorineural hearing loss caused by inner ear hemorrhage [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 97-101.
[14] Labyrinthitis is an infectious disease of the inner ear. Its main clinical manifestations are paroxysmal dizziness, vertigo, and sensorineural hearing loss. This article focuses on the otogenic bacterial labyrinthitis associated with otitis media. According to the pathological manifestations of the inner ear, labyrinthitis can be divided into three types: circumscribed labyrinthitis, serous labyrinthitis, and suppurative labyrinthitis. Circumscribed labyrinthitis, also known as labyrinth fistula, is often complicated by middle ear cholesteatoma, which usually occurs in the horizontal semicircular canal. Serous labyrinthitis is a sterile inflammation in the inner ear caused by bacterial toxins, which often leads to misdiagnosis and misjudgment. Suppurative labyrinthitis is a bacterial infectious inflammation that occurs in the inner ear that often causes severe sensorineural hearing loss and dizziness. At present, otogenic labyrinthitis is no longer rare, although it has not attracted enough attention. This article reviews the different types of otogenic bacterial labyrinthitis in a combination of domestic and foreign literature to provide clinical help for early diagnosis and treatment of patients with this condition.. The progress of otogenic bacterial labyrinthitis research [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 102-107.
[15] To investigate the effects of the sizes of adenoids and the types of torus tubarius on secretory otitis media in children. MethodsBetween March 2018 and June 2019, 120 children with secretory otitis media with complete diagnosis and treatment data in our department were allocated to the case group, and 120 normal children with corresponding physical examination data were allocated to the control group. Hearing and electronic nasopharyngoscopy were performed for the two groups of children to compare their adenoid sizes and torus tubarius types as well as analyze the association between the sizes of the adenoids and the degree of hearing loss in the case group. ResultsThe proportions of the Ⅲ-Ⅳ adenoid sizes and the Ⅱ-Ⅲ torus tubarius types were 77.5% and 77.5%, respectively, in the case group, which were higher than 37.5% and 46.7%, respectively, in the control group. The risk of disease was higher for the Ⅰ-Ⅱ adenoid sizes and the I torus tubarius type, and the differences were statistically significant(all P<0.05). The chi-squared test was performed to analyze the trends of the adenoid sizes and the torus tubarius types of the two groups, and the differences were also statistically significant(all P<0.05). However, there were no associations between the adenoid size and the torus tubarius type and hearing loss in the case group(r1= 0.135, r2 = 0.049, all P>0.05). ConclusionsAdenoid hypertrophy and the Ⅱ-Ⅲ torus tubarius types are risk factors for secretory otitis media in children. Routine examination and the evaluation of adenoids and the types of torus tubarius are helpful for early diagnosis of secretory otitis media in children.. Relationship between adenoid size and torus tubarius type and secretory otitis media in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 121-126.
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