Pediatric emergency medicine trisk 3267 3267

Comprehensive audiologic testing is paramount and should be performed as soon
as possible to document the presence, nature, and extent of hearing impairment.
Tuning fork tests (i.e., Weber and Rinne) should be performed to help determine
the likely etiology for any hearing loss. To evaluate for third-window lesions, a
high-resolution CT of the temporal bones is required. Otolaryngology should be
consulted in patients with suspected inner ear injury to determine the need for
further evaluation and management. Antibiotic treatment or admission is not
routinely indicated. However, systemic corticosteroids (1 mg/kg/day of
prednisone or an equivalent) should be administered for new onset sudden SNHL.
Steroids are most effective if initiated within 24 to 48 hours of the loss.

OTHER INJURIES ASSOCIATED WITH EAR TRAUMA
Temporal Bone Fracture
Approximately 80% of temporal bone fractures are in the longitudinal orientation
and 20% are transverse. The location may help predict associated findings
including facial nerve injury and hearing loss. Longitudinal fractures are usually
extralabyrinthine and may disrupt the bony annulus of the TM causing
hemotympanum and ossicular or TM disruption. Facial nerve injury is rare with
longitudinal fractures. Transverse fractures can disrupt the otic capsule, internal
auditory canal, and the seventh and eighth cranial nerves. Approximately half of
transverse fractures have facial nerve involvement. If the fracture involves the
otic capsule, SNHL is common. Otolaryngology should be consulted for patients
with facial nerve injury for evaluation, management, and possible emergent
decompression or repair if the nerve is severed (i.e., neurorrhaphy).

CSF Otorrhea
Longitudinal fractures that rupture the TM can lead to CSF otorrhea. Transverse
fractures have a higher incidence of CSF leak, but are less likely to have otorrhea
due to an intact TM. Clear fluid in the canal should be evaluated to determine if it
is CSF. Water, tears, or home therapies can also be present. A halo of clear fluid
around any red blood cells when placed on filter paper is concerning for CSF

(i.e., halo test). Glucose testing can also be performed. However, beta-2transferrin testing is considered the most specific test to confirm CSF otorrhea.
Avoid manipulation or instrumentation when CSF otorrhea is thought to be
present, to reduce risk of meningitis through the introduction of bacteria. Patients
with CSF otorrhea are often treated with bed rest with the head of the bed