A Prospective Study on Temporal Bone Involvement in Polytrauma Patients and the Effect of Early Diagnosis on Hearing Loss

As polytrauma cases are on the rise, a large number of patients presents with temporal bone fractures, which can result in various types of injuries varying from trivial to more serious injuries. Early diagnosis and appropriate management in required in case of serious injuries for a better outcome. The aim of my study is to study the incidence, the different injuries occurring and the effect of early diagnosis on hearing loss. Patients coming to our emergency department with polytrauma are studied and clinically evaluated for any temporal bone injuries. Based on the type of injuries audiological and radiological studies are done. And if required, biochemical tests like CSF analysis will be done. Also hearing assessment will be done as early as possible and appropriate treatment required will be started. The outcome is then assessed and followed up on a regular basis. In our study there were 90 patients with temporal bone fracture out of the 2748 polytrauma cases. The incidence was calculated to be 32 per 1000 cases. 69 patients (76.7%) had longitudinal fracture of temporal bone; 13 patients (14.4%) had transverse fracture; 2 patients (2.2%) had oblique fractures and 6 patients (6.6%) had comminuted fractures. Hearing loss was found to be the most common injury seen in 56 patients (62.2%). Of which 30 (53.5%) had conductive hearing loss (CHL); 9 (16%) had sensorineural hearing loss (SNHL); 17 had mixed hearing loss (MHL). 27 (90%) out of 30 patients with CHL showed improvement in hearing. Out of the 26 patients with SNHL and MHL, 22 patients (84.61%) showed improvement. 5 out of 6 with immediate onset facial palsy and 6 out of 8 with late onset facial palsy showed improvement. The hearing outcome in our study was found to be much better than the previous year which shows that the difference might be due to the early diagnosis and management. In our study hearing improvement was noted in most patients with hearing loss when compared to the previous year, which may have been due to the detection of the injuries at the earliest and managing the same with appropriate treatment modalities.