• M A Rafferty, R Mc Conn Walsh, and M A Walsh.
• Department of Otolaryngology/Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.
• Clin Otolaryngol. 2006 Aug 1; 31 (4): 287-91.

ObjectivesTo compare the traditional and otic capsule classification system of temporal bone fractures for clinical relevance.DesignA retrospective review of all patients with a radiological diagnosis of a skull-base fracture over a 5-year period.SettingAll patients were seen at Beaumont Hospital, the national tertiary referral centre for Neuro-otology.ParticipantsPatients with a clinical diagnosis of skull fracture were identified from the hospitals in patient enquiry (HIPE) database. Of 338 patients, 31 (9%) were identified as having a temporal bone fracture on high-resolution CT scanning.Main Outcome And MeasuresThe rate and distribution of each major clinical complications within each classification system to establish if either one was more clinically useful.ResultsFractures were classified as mixed in 14 (45%), longitudinal in 9 (29%) and horizontal in 8 (26%). Alternatively, 2 (7%) were otic capsule violating and 29 (93%) were otic capsule sparing. Seventeen patients (54.8%) sustained a hearing loss. Seven patients (23%) sustained a facial nerve injury. Four (13%) developed a cerebrospinal fluid (CSF) leak. Of all clinical findings only sensorineural hearing loss occurred significantly more often in the horizontal as opposed to the longitudinal group (P = 0.029) and in the otic violating as opposed to the otic sparing group (P = 0.013).ConclusionsWe acknowledge that the relatively small size of our cohort diminishes the statistical power of our conclusions. However, we found that the otic capsule-based classification system was not significantly better than the traditional system in predicting the likelihood of sustaining specific injuries from fractures of the temporal bone.

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