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Appropriate hearing screening in the pediatric patient with head trauma
Michael K Bowman1, Belinda Mantle, Neil Accortt
1University of Alabama, Birmingham, USA.
Insights
Children with head trauma need audiologic screening. A new algorithm identifies hearing loss in pediatric patients with skull fractures or temporal bone injuries, improving early detection.
Area of Science:
- Pediatric audiology
- Trauma care
- Neuroscience
Background:
- Head trauma in children can lead to acquired hearing loss.
- Early identification of hearing impairment is crucial for developmental outcomes.
- Standardized screening protocols for at-risk pediatric populations are needed.
Purpose of the Study:
- To develop and evaluate an algorithm for audiologic screening in children with head trauma.
- To identify risk factors associated with hearing loss following pediatric head injury.
Main Methods:
- Prospective study of 50 children with head trauma (Glasgow Coma Scale ≤13 and/or loss of consciousness).
- Audiologic evaluations including tympanometry, otoacoustic emissions, and audiometry were performed.
- Analysis of risk factors such as fracture type, age, and injury severity scores.
Main Results:
- 34% of children with head trauma exhibited abnormal hearing test results.
- Temporal bone fracture was the strongest predictor of hearing loss (p=0.0041).
- Non-temporal bone skull fractures (p=0.0211) and younger age (p=0.0638) were also associated with hearing impairment.
Conclusions:
- Children with head trauma and evidence of temporal bone fracture require prompt hearing evaluation.
- The proposed algorithm, considering factors like skull fractures and age, can efficiently identify pediatric hearing loss.
- Implementing this algorithm may lead to more cost-effective screening of hearing loss in children with head injuries.
Purpose:
To develop an algorithm for the appropriate audiologic screening of in children with head trauma.
Methods:
Participants were the first consecutive 50 children admitted to a children's hospital trauma service after October 1, 2005, whose injuries resulted in a Glasgow Coma Scale (GCS) score ≤13 and/or loss of consciousness (LOC) but no history of hearing loss. Screening tympanometry, otoacoustic emissions testing, and/or routine audiometric evaluation were performed as soon as possible after admission. Age, GCS score, Pediatric Trauma Score, Injury Severity Score, presence of head and neck soft tissue injury, temporal bone fracture, skull fracture not involving the temporal bone, midface/mandible fractures, intracranial abnormality on computed tomography, and cervical fracture were analyzed as risk factors for hearing loss.
Results:
Seventeen (34%) of the 50 children had abnormal hearing test results. Fischer's exact test showed abnormal test results were most strongly related to temporal bone fracture (p=0.0041), non-temporal bone skull fracture (p=0.0211) and younger age (p=0.0638).
Conclusions:
Any child with head trauma and clinical or radiologic evidence of temporal bone fracture should have early hearing evaluation. Using the proposed algorithm to test children with head trauma and GCS ≤13 and/or LOC and age <3 years or any type of skull fracture may help identify children with hearing loss in a more cost effective manner.
