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