Thorén Hanna, Mäyränpää Mervi K, Mäkitie Antti, Niemensivu Riina, Suominen Auli, Snäll Johanna
Department of Oral and Maxillofacial Surgery, University of Turku and Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland.
Department of Radiology, HUS Diagnostic Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Craniomaxillofac Surg. 2023 Jan;51(1):24-30. doi: 10.1016/j.jcms.2023.01.011. Epub 2023 Jan 25.
This retrospective study aimed to clarify the occurrence and types of otologic injuries in children and adolescents with skull fractures. Files of all patients under 18 years of age who had been diagnosed with skull fractures at a tertiary trauma centre were included. The primary outcome variable was the presence of any otologic symptom or finding. Secondary outcome variables were clinically detected and radiologically detected otologic injuries. The primary predictor variable was a temporal bone fracture. Other study variables were sex, age, mechanism of injury, traumatic brain injury, and mortality. A total of 97 patients were identified for the study. Otologic symptoms and findings were frequent (33.9%). The most common clinical findings were bleeding from the external auditory canal (18.6%) and hemotympanum (13.4%). The prevailing radiological finding was blood and/or cerebrospinal fluid in the middle ear (30.9%). Patients with fractures of temporal bone had a 29-fold risk for otologic symptoms or findings (RR 28.9, 95% CI 4.1-202.9, p < 0.001) relative to those who did not have a temporal bone fracture. Severe otologic complications, such as permanent hearing loss (6.2%), cerebrospinal fluid leak (5.2%), or facial nerve palsy (1%), were infrequent. Within the limitations of the study it seems that there is the necessity of otoscopy in all pediatric patients with blunt head trauma. In case of positive otologic findings, the patient should undergo imaging and ENT consultation.
这项回顾性研究旨在明确颅骨骨折患儿及青少年耳科损伤的发生率及类型。纳入了在一家三级创伤中心被诊断为颅骨骨折的所有18岁以下患者的病历。主要结局变量为是否存在任何耳科症状或体征。次要结局变量为临床检测到的和放射学检测到的耳科损伤。主要预测变量为颞骨骨折。其他研究变量包括性别、年龄、损伤机制、创伤性脑损伤和死亡率。共确定97例患者纳入研究。耳科症状和体征很常见（33.9%）。最常见的临床体征为外耳道出血（18.6%）和中耳积血（13.4%）。主要的放射学表现为中耳内有血液和/或脑脊液（30.9%）。与无颞骨骨折的患者相比，颞骨骨折患者出现耳科症状或体征的风险高29倍（相对危险度28.9，95%可信区间4.1 - 202.9，p < 0.001）。严重的耳科并发症，如永久性听力丧失（6.2%）、脑脊液漏（5.2%）或面神经麻痹（1%）并不常见。在本研究的局限性范围内，似乎所有钝性头部外伤的儿科患者都有必要进行耳镜检查。如果耳科检查结果呈阳性，患者应接受影像学检查并咨询耳鼻喉科医生。
