Long-Term Outcomes of Acute Temporal Bone Fractures

Objective(s): To compare the incidence of acute and chronic complications of temporal bone fractures, and identify predictors for post-injury, audiometrically confirmed hearing loss.

Methods: Retrospective cohort analysis of patients with acute temporal bone fractures who underwent both in-hospital and outpatient follow-up Otolaryngology evaluation at an academic, tertiary-care institution from January 2002 to January 2023. Otologic outcomes were compared between initial and follow-up evaluations. Logistic regression analysis was used to identify predictors of audiometric hearing loss.

Results: 577 subjects with acute injuries were reviewed; 220 met inclusion criteria. Compared with initial evaluation, the incidence of hemotympanum (57% vs. 5%, p < 0.001), external auditory canal injury (18% vs. 8%, p = 0.01), facial nerve weakness (7% vs. 4%, p = 0.016), and cerebrospinal fluid otorrhea (6% vs. 0%, p < 0.001) significantly decreased at follow-up. There were no differences in rates of subjective hearing loss, tympanic membrane injury, or ossicular disruption. Formal audiograms were performed in 82 subjects. 47 (57%) demonstrated hearing loss, almost half of which were pure sensorineural. Multivariate regression identified age (Odds Ratio [OR]: 1.03, p = 0.036), intracranial bleeding (OR: 7.49, p = 0.004), and lateral dural venous sinus thrombosis (OR: 10.5, p = 0.039) as predictors for audiometric loss.

Conclusions: Temporal bone fractures are complex injuries often associated with numerous intra-temporal and extra-temporal complications. Various otological sequelae persist upon hospital discharge. Yielding insight about the natural history of such injuries, these results aid in patient counseling, identifying subjects at risk for long-term problems, and necessitating follow-up.

Level of evidence: IV Laryngoscope, 2024.