Temporal Bone Fracture in Children

Children are especially prone to trauma. They are more likely to fall than adults and they are more likely to sustain a fracture while in a motor vehicle accident. Sports injuries are also a phenomenon of the youth. One study looked at the causes, the signs and symptoms as well as the management of temporal bone fractures in kids. This was a case control study.

The researchers looked at a retrospective review of children admitted to a level I pediatric trauma center from July 1, 1990 through November 1, 1996. A total 680 patients were found in the study and all were less than 14-years-old with blunt temporal lobe trauma identified in 122 patients. Unfortunately, only 97 charges were available to be reviewed by the research team.

There were criteria for temporal lobe fractures that included radiologic findings and clinical information. Patients with CT-defined temporal lobe fractures were included as well as those who also had an examination by an otolaryngologist or equivalent, and audiometric evaluations. Three separate age groups were included in the study. The data were compared with previously available pediatric and adult temporal bone fracture studies.

There were 72 children in the study with 79 temporal bone fractures. As is typical of traumatic injuries, there were more boys than girls with 47 boys and 25 girls. The patients’ age groups were between 6 months of age to 14 years of age with peak ages at 3 years and at 12 years of age. The most common cause of the injuries involved motor vehicle accidents at 47 percent, falls at 40 percent, bicycle accidents at 8 percent and blows striking the head at 7 percent.

Most kids showed up with hearing loss at 82 percent, blood behind the tympanic membrane at 81 percent, loss of consciousness at 63 percent, brain injuries at 58 percent, fractures of the extremities at 8 percent and damage to the facial nerve at 3 percent. Blood came from the ear 58 percent of the time. Forty-two patients had what was believed to be leakage of the cerebral spinal fluid through the ear along with blood in the external canal.

Patients received IV antibiotic–in 24 patients. None of the patients had prolonged leakage from the ear and none had meningitis. Patients were found to have transverse fractures a total of 6 percent of the time, oblique fractures 10 percent of the time, longitudinal fractures 54 percent of the time and squamous fractures 27 percent of the time. A total of 59 percent of patients developed hearing loss; conductive hearing loss was the most common type of hearing loss at 56 percent of the patients. Sensorineural hearing loss was found in 17 percent and mixed hearing loss was described in 10 percent.

The researchers concluded by saying that pediatric trauma causing temporal bone fractures were likely to occur in motor vehicle accidents and falls. There seems to be a great deal of intracranial injury in many of the children and hearing loss is common. Facial nerve injuries aren’t that common.