The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
University of North Carolina, Department of Otolaryngology - Head and Neck Surgery, Chapel Hill, North Carolina.
West J Emerg Med. 2022 Feb 9;23(2):238-245. doi: 10.5811/westjem.2021.11.52704.
Temporal bone computed tomography (CT) requires a relatively high radiation dose to produce high-resolution images required to define surgical anatomy. In the acute setting, the need for this detailed evaluation of temporal bone pathology may not be required for nonsurgical management and clinical decision-making. We performed a retrospective review of the clinical characteristics and subsequent management of children who underwent CT of the temporal bone with the goal of optimizing clinical decision-making and mitigating the risks of radiation exposure in children.
We included pediatric patients (<18 years of age) with International Classification of Diseases (9th or 10th revision) diagnoses consistent with otitis externa, otitis media, mastoiditis, head trauma, temporal bone fracture, and otalgia who were treated in the emergency department and underwent temporal bone CT from January 1, 2012-December 31, 2016. We collected data regarding the patients' presenting symptoms, physical exam findings, indications for imaging, radiographic findings, disposition, and operative intervention within 30 days of imaging. Features of the suspected mastoiditis group were compared between operative and non-operative patients.
Over the four-year study period there were 96 temporal bone CTs. Most studies (70%) were associated with a subsequent inpatient admission. Common indications for imaging included evaluation of acute mastoiditis (55%) or trauma (41%). Of the 53 patients with concern for mastoiditis, 27 (51%) required otologic surgery. Two patients in the trauma group required surgical intervention, both for facial nerve decompression. In patients with suspected mastoiditis, mental status changes (P = 0.02), auricular proptosis (P = 0.05), and fluctuance (P = 0.02) were significantly more prevalent in the operative group; however, no other findings were significantly associated with operative intervention.
Temporal bone CT is beneficial in guiding diagnosis and management of acute mastoiditis. We found that a majority of patients with suspected mastoiditis who underwent temporal bone CT ultimately required surgery or hospital admission. However, the potential for reduction in the use of CT still exists in this population. Fractures of the temporal bone typically do not require urgent operative intervention in the absence of complete facial nerve paralysis; thus, the utility of temporal bone CT in trauma evaluation may be limited.
颞骨计算机断层扫描（CT）需要相对较高的辐射剂量才能生成用于定义手术解剖结构的高分辨率图像。在急性情况下，对于非手术管理和临床决策而言，可能不需要对颞骨病理进行这种详细评估。我们对接受颞骨 CT 检查的儿童的临床特征和后续治疗进行了回顾性分析，目的是优化临床决策并减轻儿童辐射暴露的风险。
我们纳入了 2012 年 1 月 1 日至 2016 年 12 月 31 日在急诊科就诊并接受颞骨 CT 检查的年龄＜18 岁的国际疾病分类（第 9 或第 10 版）诊断为外耳道炎、中耳炎、乳突炎、头部外伤、颞骨骨折和耳痛的患儿。我们收集了有关患者的主要症状、体格检查结果、影像学检查指征、影像学表现、处置方式和影像学检查后 30 天内手术干预的信息。对比了手术和非手术患者疑似乳突炎组的特征。
在四年的研究期间，共有 96 例颞骨 CT 检查。大多数研究（70%）与随后的住院治疗有关。常见的影像学检查指征包括急性乳突炎（55%）或外伤（41%）的评估。在 53 例疑似乳突炎的患者中，27 例（51%）需要耳科手术。在创伤组中，有 2 例患者需要手术干预，均为面神经减压术。在疑似乳突炎的患者中，精神状态改变（P = 0.02）、耳郭突出（P = 0.05）和波动感（P = 0.02）在手术组中更为常见；然而，没有其他发现与手术干预有显著相关性。
颞骨 CT 有助于指导急性乳突炎的诊断和治疗。我们发现，大多数接受颞骨 CT 检查的疑似乳突炎患者最终需要手术或住院治疗。然而，在该人群中仍有减少 CT 使用的潜力。颞骨骨折在没有完全面神经瘫痪的情况下通常不需要紧急手术干预；因此，颞骨 CT 在创伤评估中的作用可能有限。
