title: Pediatric temporal bone fractures: current trends and comparison of classification schemes.
abstract: OBJECTIVE
  1) Characterize the current presentation of pediatric temporal bone fractures, 2) compare two classification schemes for temporal bone fractures and illustrate complications in each fracture type.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Tertiary-care, academic children's hospital.
  
  
  METHODS
  All children presenting from 1999 to 2009 with CT-proven temporal bone fracture and audiology examination with follow-up.
  
  
  METHODS
  All CT scans were reinterpreted by a dedicated head and neck radiologist. All fractures were characterized as otic capsule sparing (OCS) or otic capsule violating (OCV), as well as transverse (T) or longitudinal (L).
  
  
  RESULTS
  CT findings, mechanisms of injury, sensorineural hearing loss (SNHL), conductive hearing loss (CHL), and facial nerve injury (FNI).
  
  
  RESULTS
  Seventy-one children met inclusion criteria. Fifty-four (76%) children had longitudinal fractures versus 17 (24%) with transverse fractures. Sixty-four (90%) had OCS versus 7 (10%) with OCV. The otic capsule was involved in 7.4% of longitudinal fractures and 17.6% of transverse fractures. Eleven (15%) had facial weakness, 72% of whom had a visualized fracture through the facial nerve course. SNHL was detected in 14 (20%) patients and CHL in 17(23.9%). All patients with fractures classified as both transverse and OCV had SNHL. The OCS versus OCV and T versus L classification schemes were directly compared for statistical significance in predicting SNHL, CHL, and FNI using the Fisher's exact test. Both OCS/OCV and T/L were predictors of SNHL (P = .0025 and P = .0143, respectively), but the OCS/OCV scheme was more accurate. Neither classification significantly predicted CHL or FNI (P = .787 versus .825; P = .705 vs. .755).
  
  
  CONCLUSIONS
  In this pediatric series, approximately 75% of the fractures are longitudinal and 25% are transverse. The otic capsule is spared in 90% and violated in 10%. Both OCS/OCV and L/T classification schemes predict SNHL, but the OCV/OCS scheme is more accurate in this prediction. Although the negative predictive value of the two schemes is similar, the positive predictive value is higher with the OCS/OCV system. The presence of conductive hearing loss and facial nerve symptoms was not predicted by either classification system.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Joshua
authors.initials: J
authors.lastname: Dunklebarger
authors.forename: Barton
authors.initials: B
authors.lastname: Branstetter
authors.forename: Anne
authors.initials: A
authors.lastname: Lincoln
authors.forename: Megan
authors.initials: M
authors.lastname: Sippey
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen
authors.forename: Barbara
authors.initials: B
authors.lastname: Gaines
authors.forename: David
authors.initials: D
authors.lastname: Chi
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D017677:Age Distribution; D001301:Audiometry, Pure-Tone; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D020220:Facial Nerve Injuries / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006314:Hearing Loss, Conductive / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012887:Skull Fractures / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging*; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Otology; general otolaryngology; pediatric ears/otology; pediatric trauma