title: A comparison of temporal bone fracture classification systems.
abstract: OBJECTIVE
  To compare the traditional and otic capsule classification system of temporal bone fractures for clinical relevance.
  
  
  METHODS
  A retrospective review of all patients with a radiological diagnosis of a skull-base fracture over a 5-year period.
  
  
  METHODS
  All patients were seen at Beaumont Hospital, the national tertiary referral centre for Neuro-otology.
  
  
  METHODS
  Patients with a clinical diagnosis of skull fracture were identified from the hospitals in patient enquiry (HIPE) database. Of 338 patients, 31 (9%) were identified as having a temporal bone fracture on high-resolution CT scanning.
  
  
  METHODS
  The rate and distribution of each major clinical complications within each classification system to establish if either one was more clinically useful.
  
  
  RESULTS
  Fractures were classified as mixed in 14 (45%), longitudinal in 9 (29%) and horizontal in 8 (26%). Alternatively, 2 (7%) were otic capsule violating and 29 (93%) were otic capsule sparing. Seventeen patients (54.8%) sustained a hearing loss. Seven patients (23%) sustained a facial nerve injury. Four (13%) developed a cerebrospinal fluid (CSF) leak. Of all clinical findings only sensorineural hearing loss occurred significantly more often in the horizontal as opposed to the longitudinal group (P = 0.029) and in the otic violating as opposed to the otic sparing group (P = 0.013).
  
  
  CONCLUSIONS
  We acknowledge that the relatively small size of our cohort diminishes the statistical power of our conclusions. However, we found that the otic capsule-based classification system was not significantly better than the traditional system in predicting the likelihood of sustaining specific injuries from fractures of the temporal bone.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: M A
authors.initials: MA
authors.lastname: Rafferty
authors.forename: R
authors.initials: R
authors.lastname: Mc Conn Walsh
authors.forename: M A
authors.initials: MA
authors.lastname: Walsh
mesh_terms: D001930:Brain Injuries / Q000150:complications; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D015331:Cohort Studies; D005158:Facial Paralysis / Q000209:etiology; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D011859:Radiography; D012189:Retrospective Studies; D012887:Skull Fractures / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging; D013701:Temporal Bone / Q000293:injuries*