Management of Temporal Bone Fractures: Optimizing the Role of Otolaryngology Consultation

OBJECTIVE: Determine which patients can be safely seen on an outpatient basis after a temporal bone fracture without inpatient otolaryngology consultation. STUDY DESIGN: Single-center retrospective cohort study. SETTING: Primary Adult Resource Center for Trauma. METHODS: Patients with a radiographically confirmed temporal bone fracture between 2018 and 2022 were included. Facial nerve function, presence of cerebrospinal fluid (CSF) leak, and inpatient interventions were assessed. Clinical and radiographic factors were analyzed for effectiveness in screening patients that required inpatient otolaryngology intervention. RESULTS: Of 171 included patients, 37 (21.6%) had bilateral fractures. Most were male (n = 126, 73.7%) with average age 41.3 years (SD 17.8). 12 (7%) had otic capsule involvement. Three patients required inpatient surgical intervention. 31 patients had immediate or delayed facial weakness and 14 had CSF otorrhea. Utilizing acute facial nerve paresis or paralysis, clear otorrhea, bloody otorrhea, or otic-capsule involvement to screen for otolaryngology consultation resulted in the highest sensitivity (93.5%) and negative predictive value (97.3%, NPV) for post-traumatic facial nerve dysfunction and 100% sensitivity and 100% NPV for any post-traumatic CSF otorrhea. This would result in 73 (42.7%) fewer inpatient otolaryngology consults. Utilizing only acute facial injury and clear otorrhea as criteria resulted in fewer consultations; while specificity for CSF leak and facial nerve injury increased, sensitivity and NPV both decreased. CONCLUSION: Patients with temporal bone fractures who can safely follow-up as outpatients without inpatient otolaryngology consultation can be effectively identified. This will decrease unnecessary inpatient consultation volumes, optimize primary team workflow, and may result in potential cost savings.