Padmakumar Vishnupriya, Ramesh Kumar E, Ramakrishnan V R
Department of Otorhinolaryngology, Head and Neck Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala 680005 India.
Indian J Otolaryngol Head Neck Surg. 2020 Mar;72(1):30-35. doi: 10.1007/s12070-019-01723-w. Epub 2019 Jul 31.
As polytrauma cases are on the rise, a large number of patients presents with temporal bone fractures, which can result in various types of injuries varying from trivial to more serious injuries. Early diagnosis and appropriate management in required in case of serious injuries for a better outcome. The aim of my study is to study the incidence, the different injuries occurring and the effect of early diagnosis on hearing loss. Patients coming to our emergency department with polytrauma are studied and clinically evaluated for any temporal bone injuries. Based on the type of injuries audiological and radiological studies are done. And if required, biochemical tests like CSF analysis will be done. Also hearing assessment will be done as early as possible and appropriate treatment required will be started. The outcome is then assessed and followed up on a regular basis. In our study there were 90 patients with temporal bone fracture out of the 2748 polytrauma cases. The incidence was calculated to be 32 per 1000 cases. 69 patients (76.7%) had longitudinal fracture of temporal bone; 13 patients (14.4%) had transverse fracture; 2 patients (2.2%) had oblique fractures and 6 patients (6.6%) had comminuted fractures. Hearing loss was found to be the most common injury seen in 56 patients (62.2%). Of which 30 (53.5%) had conductive hearing loss (CHL); 9 (16%) had sensorineural hearing loss (SNHL); 17 had mixed hearing loss (MHL). 27 (90%) out of 30 patients with CHL showed improvement in hearing. Out of the 26 patients with SNHL and MHL, 22 patients (84.61%) showed improvement. 5 out of 6 with immediate onset facial palsy and 6 out of 8 with late onset facial palsy showed improvement. The hearing outcome in our study was found to be much better than the previous year which shows that the difference might be due to the early diagnosis and management. In our study hearing improvement was noted in most patients with hearing loss when compared to the previous year, which may have been due to the detection of the injuries at the earliest and managing the same with appropriate treatment modalities.
随着多发伤病例的增加，大量患者出现颞骨骨折，这可能导致从轻微到更严重的各种类型损伤。对于严重损伤，需要早期诊断和适当处理以获得更好的结果。我的研究目的是研究发病率、发生的不同损伤以及早期诊断对听力损失的影响。对因多发伤前来我们急诊科的患者进行研究，并对是否存在任何颞骨损伤进行临床评估。根据损伤类型进行听力学和放射学检查。如有需要，将进行脑脊液分析等生化检查。还将尽早进行听力评估，并开始所需的适当治疗。然后对结果进行评估并定期随访。在我们的研究中，2748例多发伤病例中有90例颞骨骨折患者。发病率计算为每1000例中有32例。69例患者（76.7%）为颞骨纵行骨折；13例患者（14.4%）为横行骨折；2例患者（2.2%）为斜行骨折；6例患者（6.6%）为粉碎性骨折。听力损失是56例患者（62.2%）中最常见的损伤。其中30例（53.5%）为传导性听力损失（CHL）；9例（16%）为感音神经性听力损失（SNHL）；17例为混合性听力损失（MHL）。30例CHL患者中有27例（90%）听力有所改善。在26例SNHL和MHL患者中，22例（84.61%）有所改善。6例立即发生面瘫的患者中有5例、8例迟发性面瘫的患者中有6例有所改善。我们研究中的听力结果比上一年好得多，这表明差异可能归因于早期诊断和处理。在我们的研究中，与上一年相比，大多数听力损失患者的听力有所改善，这可能是由于最早发现损伤并采用适当的治疗方式进行处理。
