title: Cost effective use of audiograms after pediatric temporal bone fractures.
abstract: OBJECTIVE
  To identify the relationship of pediatric temporal fractures to the incidence and type of hearing loss present. To analyze the timing and utility of audiometric testing in children with temporal bone fractures.
  
  
  METHODS
  Retrospective case series of 50 pediatric patients with temporal bone fractures who were treated at an urban, tertiary care children's hospital from 2008 to 2014. A statistical analysis of predictors of hearing loss after temporal bone fracture was performed.
  
  
  RESULTS
  Fifty-three fractures (69.7%) in 50 patients involved the petrous portion of the temporal bone. The mean age of patients was 7.13 years, and 39 (73.6%) were male. A fall was the most common mechanism of injury in 28 (52.8%) patients, followed by crush injury (n=14, 26.2%), and vehicular trauma (n=10, 18.9%). All otic capsule violating fractures were associated with a sensorineural hearing loss (n=4, 7.5%, p=0.002). Three of four otic capsule sparing fractures were associated with ossicular dislocation, with a corresponding mixed or conductive hearing loss on follow up audiometric testing. The majority of otic capsule sparing fracture patients (n=19/43, 44.2%) who had follow up audiograms had normal hearing, and those with otic capsule violating fractures were statistically more likely to have persistent hearing loss than those with otic capsule sparing fractures (p=0.01).
  
  
  CONCLUSIONS
  Patients with otic capsule violating fractures or those with ossicular disruption are at higher risk for persistent hearing loss. Cost-saving may be accrued by selecting only those patients at high risk for persistent hearing loss for audiometric testing after temporal bone fractures.
authors.affiliation: University of Illinois at Chicago, Department of Otolaryngology - Head and Neck Surgery, 1855 West Taylor Street, Chicago, IL 60612, United States.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Frisenda
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology - Head and Neck Surgery, 225 E. Chicago Ave, Box#25, Chicago, IL, United States; Northwestern University Feinberg School of Medicine, 303 East Chicago Ave, Chicago, IL 60611, United States.
authors.forename: James W
authors.initials: JW
authors.lastname: Schroeder
authors.affiliation: Northwestern University Feinberg School of Medicine, 303 East Chicago Ave, Chicago, IL 60611, United States; Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Medical Imaging, Chicago, IL, United States.
authors.forename: Maura E
authors.initials: ME
authors.lastname: Ryan
authors.affiliation: University of Illinois at Chicago, Department of Otolaryngology - Head and Neck Surgery, 1855 West Taylor Street, Chicago, IL 60612, United States.
authors.forename: Taher S
authors.initials: TS
authors.lastname: Valika
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology - Head and Neck Surgery, 225 E. Chicago Ave, Box#25, Chicago, IL, United States; Northwestern University Feinberg School of Medicine, 303 East Chicago Ave, Chicago, IL 60611, United States. Electronic address: kbillings@luriechildrens.org.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Billings
mesh_terms: D000293:Adolescent; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D013701:Temporal Bone / Q000293:injuries*
keywords: Cost effectiveness; Pediatric head trauma; Pediatric temporal bone fractures; Skull base fractures; Temporal bone fractures; Trauma related hearing loss