Clinical Case Study of Facial Nerve Paralysis with Sensorineural Hearing Loss and Tinnitus Caused by Traumatic Temporal Bone Fracture

AbstrakPendahuluan: Paralisis saraf fasialis merupakan salah satu komplikasi fraktur tulang temporal. Fraktur tulang temporal dapat berupa fraktur longitudinal, transversal maupun campuran. Paralisis saraf fasialis lebih banyak ditemukan pada fraktur tulang transversal dibandingkan longitudinal. Penatalaksanaan paralisis saraf fasialis akibat fraktur tulang temporal masih kontroversi, dapat berupa terapi medikamentosa maupun terapi bedah. Metode: Satu kasus paralisis saraf fasialis akibat fraktur temporal longitudinal tahun yang ditatalaksana dengan terapi medikamentosa. Hasil: Terdapat peningkatan fungsi saraf pasialis dengan terapi medikamentosa pada paralisis parsial saraf fasialis akibat fraktur temporal longitudinal. Diskusi: Penatalaksanaan paralisis saraf fasialis akibat fraktur tulang temporal masih merupakan hal yang kontroversial. Pasien dengan paralisis parsial (House Brackmann II-V) cukup dilakukan observasi dan terapi dengan steroid berupa prednison, sedangkan pada paralisis komplit (House Brackmann VI), terapi medikamentosa dengan steroid dapat dikombinasikan dengan terapi bedah berupa dekompresi atau grafting. Pertimbangan untuk melakukan pembedahan tergantung dari pemeriksaan CT Scan dan tes elektrofisiologisKata kunci: Paralisis saraf fasialis, fraktur tulang temporal, terapi medikamentosaAbstractFacial nerve paralysis is one of the temporal bone fracture complications. Temporal bone fracture is classified as longitudinal, transversal and mixed type. Facial nerve paralysis is more common in transversal rather than longitudinal type. The treatment of facial nerve paralysis due to temporal bone fracture still remain controversial, whether its medical therapy or surgical approach.Methode: One case of facial nerve paralysis caused by longitudinal type of temporal bone fracture has been treated by medical therapy. Result: There is an increase of facial nerve function treated with medical therapy in a case of partial nerve paralysis due to longitudinal type of temporal bone fracture. Discussion: Management of facial nerve paralysis due to temporal bone fracture is still controversial. Patient with partial paralysis (House Brackmann II-V) treated with observation and medical therapy using steroid, whereas complete paralysis (House Brackmann VI) treated with medical therapy using steroid, combine with decompression and grafting surgery. Considerations for surgery depend on computed tomography and electrophysiology examination.Keywords: Facial nerve paralysis, temporal bone fracture, medical therapy

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Comparison of the application of artificial ossicles and autologous ossicles in the reconstruction of a damaged ossicular chain

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001627 ◽

2018 ◽

Vol 132 (10) ◽

pp. 885-890

Author(s):

L Zhao ◽

J Li ◽

S Gong

Keyword(s):

Facial Nerve ◽

Temporal Bone ◽

Pure Tone ◽

Bone Fractures ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Facial Nerve Paralysis ◽

Temporal Bone Fracture ◽

Nerve Paralysis ◽

Ossicular Reconstruction

AbstractObjectiveTo evaluate the therapeutic effect that the titanium partial ossicular reconstruction prosthesis and autologous ossicles have on hearing loss after reconstruction of a damaged ossicular chain.MethodsForty-two medical records of treatments carried out from 2013 to 2015 for ossicular chain damage with facial nerve paralysis due to temporal bone fractures were reviewed. The study assessed: causes of damage, pre-operative pure tone audiometry findings, types of intra-operative ossicular chain damage, intra-operative ossicular chain repair methods (titanium partial ossicular reconstruction prosthesis or autologous ossicles) and post-operative pure tone audiometry results.ResultsThe titanium partial ossicular reconstruction prosthesis was used in 26 cases; the average air–bone gap was 32.3 ± 5.3 dB pre-operatively and 12.8 ± 5.3 dB post-operatively. Autologous ossicles were used in 16 cases; the average air–bone gap was 33.4 ± 4.5 dB pre-operatively and 17.8 ± 7.8 dB post-operatively.ConclusionOssicular chain reconstruction is an effective way of improving hearing in patients with ossicular chain damage. The results suggest that repair with either the titanium partial ossicular reconstruction prosthesis or autologous ossicles can improve hearing following ossicular chain injury with facial nerve paralysis caused by a temporal bone fracture.

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Facial nerve palsy as the first sign of late breast cancer metastasis to the temporal bone

Vojnosanitetski pregled ◽

10.2298/vsp210212040d ◽

2021 ◽

pp. 40-40

Author(s):

Zoran Dudvarski ◽

Nenad Arsovic ◽

Milovan Dimitrijevic ◽

Sasa Jakovljevic ◽

Novica Boricic ◽

...

Keyword(s):

Breast Cancer ◽

Hearing Loss ◽

Facial Nerve ◽

Temporal Bone ◽

Cancer Metastasis ◽

Metastatic Breast ◽

Breast Cancer Metastasis ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Radiological Diagnostics

Introduction. Late metastases of malignant tumors in the temporal bone are very rare lesions. They can be asymptomatic for a long time, and usually manifest themselves in the form of hearing loss, dizziness, tinnitus, and paralysis of the facial nerve. Modern radiological diagnostics and explorative surgery with biopsy are essential for diagnosis. Case report. We present a rare and unusual case of a 66-year-old female patient with a facial nerve paralysis that appeared as the first sign of metastatic breast cancer in the temporal bone 10 years after treatment. A sudden hearing loss and dizziness occurred six months later and value of CA 15-3 was elevated. Scintigraphy pointed to susceptible metastatic deposits of the axial skeleton, without lesions in the temporal bone. Finally, repeated computerized tomography revealed osteolytic changes of the temporal bone six months after that. Immunohistochemical analysis of mastoid tissue samples confirmed that it was a breast cancer metastasis. One year after palliative radiotherapy and oral hormone therapy, a patient has a good general condition with better function of the facial nerve. Conclusion. A high degree of clinical suspicion sometimes requires repeated radiological diagnostics in order to detect osteolytic metastatic changes in the temporal bone, but also in other bone structures within the hematogenous dissemination of the malignant disease.

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Perilymphatic fistula and pneumolabyrinth without temporal bone fracture: a rare entity

BMJ Case Reports ◽

10.1136/bcr-2018-228457 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228457 ◽

Cited By ~ 1

Author(s):

Ana Sousa Menezes ◽

Daniela Ribeiro ◽

Daniel Alves Miranda ◽

Sara Martins Pereira

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Temporal Bone ◽

Bone Fracture ◽

Round Window ◽

Sensorineural Hearing ◽

Temporal Bone Fracture ◽

Perilymphatic Fistula ◽

Hearing Thresholds ◽

Post Traumatic

Post-traumatic pneumolabyrinth is an uncommon clinical entity, particularly in the absence of temporal bone fracture. We report the case of a patient who presented to our emergency department with a headache, sudden left hearing loss and severe dizziness which began after a traumatic brain injury 3 days earlier. On examination, the patient presented signs of left vestibulopathy, left sensorineural hearing loss and positive fistula test, normal otoscopy and without focal neurological signs. The audiometry confirmed profound left sensorineural hearing loss. Cranial CT revealed a right occipital bone fracture and left frontal subdural haematoma, without signs of temporal bone fracture. Temporal bone high-resolution CT scan revealed left pneumolabyrinth affecting the vestibule and cochlea. Exploratory tympanotomy revealed perilymphatic fistula at the location of the round window. The sealing of defect was performed using lobule fat and fibrin glue. He presented complete resolution of the vestibular complaints, though the hearing thresholds remained stable.

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Conservative versus Surgical Therapy in Managing Patients with Facial Nerve Palsy Due to the Temporal Bone Fracture

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0038-1625966 ◽

2019 ◽

Vol 12 (1) ◽

pp. 20-26 ◽

Cited By ~ 2

Author(s):

Ali Abbaszadeh-Kasbi ◽

Ali Kouhi ◽

Mohammad Taghi Khorsandi Ashtiani ◽

MahtabRabbani Anari ◽

AlirezaKarimi Yazdi ◽

...

Keyword(s):

Facial Nerve ◽

Surgical Therapy ◽

Proper Time ◽

P Value ◽

Decompression Surgery ◽

Facial Nerve Paralysis ◽

Temporal Bone Fracture ◽

Nerve Paralysis ◽

Delayed Onset ◽

Significant Difference

Facial nerve paralysis is classified into immediate or delayed-onset palsy, and affected patients should be treated through conservative or surgical therapy. Appropriate treatment is somewhat debated as well as proper time for performing surgery. This study aimed to assess treatment outcome between conservatively and surgically treated groups and to determine the appropriate time of surgery in selected patients for surgery. Twenty-four patients from April 2008 to July 2015 were included. Performing decompression surgery within the first 2 months following the trauma accompanies a better prognosis ( p-value < 0.05). Eleven patients were managed conservatively, and 4 of them demonstrated immediate onset and 7 indicated delayed onset. Nine patients obtained normal nerve function, one patient had partial palsy, and one of them had complete palsy. There was no significant difference in the rate of recovery between types of the treatment ( p-value > 0.05). Decompression surgery is recommended in the first 2 months after the trauma for immediate onset and also complete degeneration on electroneuronography.

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Cochlear implant surgery at the Clinical Center of Vojvodina - ten-year experience

Medicinski pregled ◽

10.2298/mpns14s1025d ◽

2014 ◽

Vol 67 (suppl. 1) ◽

pp. 25-31

Author(s):

Dragan Dankuc ◽

Darja Segan ◽

Zoran Komazec ◽

Ljiljana Vlaski ◽

Slobodanka Lemajic-Komazec ◽

...

Keyword(s):

Hearing Loss ◽

Facial Nerve ◽

Cochlear Implant ◽

Surgical Procedures ◽

Cochlear Implantation ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Implant Surgery ◽

Clinical Center ◽

Cochlear Implant Surgery

Introduction. The first cochlear implant surgery was performed at the Center for Cochlear Implantation of the Department of Ear, Nose and Throat Diseases, Clinical Center of Vojvodina in 2002 after long preparations and that was the first successful cochlear implantation in Serbia. Material and Methods. Over the period from November 2002 to November 2013, 99 patients underwent surgical procedures and 100 cochlear implants were placed. Results. The analysis encompassed 99 patients, the youngest and the oldest one being 1 year and 61 years old, respectively. Prelingual and postlingual deafness developed in 84 (84.9%) and in 15 (15.1%), respectively. Postlingual deafness was observed in all 11 adult patients. The prelingual deafness was diagnosed in 84 (95.4%) children, whereas in four (4.6%) children it occurred after the development of speech between 6 and 8 years of age. Progressive hearing loss was observed in 11 patients - seven adults and four children. The majority of our patients, i.e. 74 (74.75%) manifested idiopathic deafness of unknown cause. A range of usually reported hearing loss etiologies included ototoxic medications in seven (7.07%), hereditary factor in six (6.06%), and bacterial meningitis in four (4.04%) patients. Somewhat less common causes were perinatal hypoxia in three (3.03%), premature birth in three (3.03%), Down syndrome in one (1.01%), and chronic otitis media in one (1.01%) patient. Conclusion. Both intraoperative and postoperative complications were analyzed in the investigated patient population. The complications developed in 11 patients, i.e. in 10.5% of 105 surgical procedures. The majority of procedures (89.5%) were not accompanied by any post-surgical complications. Unsuccessful implantation in a single-step procedure and transient facial nerve paralysis can be considered most frequent among our patients, whereas cochlear ossification and transient ataxia occurred more rarely. Stimulation of facial nerve, intraoperative perilymph liquid gusher, device failure and late infections were recorded extremely rarely.

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