**7. Conclusion**

152 Hearing Loss

Bleeding from the ear was noticed to be due to laceration in the external auditory canal. Patients having ear bleeding were called after a week for auditory assessment, no active intervention was needed. 1 patient had ottis externa which was treated conservatively.

7%(4)

2%(1)

5%(3)\_

FRONTAL TEMPORAL OCCIPITAL PARIETAL FACIAL BONE

NORMAL

3%(2)

8%(5)

Out of 60 patients a total number of 15 patients were found to have skull fractures (fig-16). Of 5 patients with frontal bone fractures bilateral hearing loss was noticed in all the patients,

In patients who sustained temporal bone fractures, mixed fractures were seen in two patients, one patient had longitudinal fracture, and one had transverse fracture. Sensorineural hearing loss was found in four ears, mixed hearing loss was found in one ear, conductive hearing loss was noticed in one ear, and two ears were found to be

Sensorineural hearing loss was noticed in the patient who sustained a fracture of the

Out of the three patients who sustained parietal bone fractures two patients were found to have normal hearing, the third patient had sensorineural hearing loss in one ear which

Bilateral sensorineural hearing loss was detected in patients who sustained facial bone

Only one patient with parietal bone fracture with normal hearing complained of vertigo in

Out of the four patients who fell from a height three patients had normal hearing and one had conductive hearing loss. Parietal bone fracture was detected in one patient who had

of which mixed hearing loss improved but did not become normal.

became normal and mixed hearing loss in the other ear that improved.

which positional test was negative and was treated conservatively.

normal hearing. Hearing loss progressed in one patient.

Fig. 16. Distribution of fractures

75%(45)

normal.

fractures.

occipital bone.

This prospective study was done in a tertiary care teaching hospital to look at the incidence of hearing loss in patients who sustained minor head injury. The behavior of hearing loss was evaluated by serial assessment of hearing. Road traffic accidents (RTA) were the most common cause of Minor head injury as seen in all studies. The incidence of road traffic accidents in age groups 20-50 years, in our study, was similar to the study done by Ludwig podoshin and M R Abd AL-Hady. Whereas in the study done by Griffith, the majority were seen in late teens.

Two wheeler accidents were found to be the commonest cause of RTA causing minor head injury in our study, whereas another study ( George .G.Browning at al 1982) reported that assault /fight was the major etiology causing minor head injury. 75% of the RTA's were two wheeler accidents and none of them were wearing helmets at the time of accident. In about 40% of our patient's consumption of alcohol would have contributed to the road traffic accident.

Symptoms of hearing loss were found in only 10% of patients which is in agreement with Harold F.Schuknecht (1956) and Kazumi Makashima et al (1975) due to the involvement in high frequency region. The symptoms of vertigo were found to be 15% which is low as compared with Toglia JU et al (1970) who reported an incidence of 61% and Rosalyn et al (1995) who reported 95% of patients with symptoms of vertigo . Additionally a low Incidence of tinnitus was observed which is in agreement with Griffith. The incidence of Hearing loss in our study is 62% which is in agreement with a previous study Griffith (56%) with males being most affected.

The commonest type of hearing loss was sensorineural loss confined to high frequencies. The degree of hearing loss determined the out come, and it was found in our study that patients who had moderate to severe hearing loss at the time of injury had a poorer prognosis as compared to those with normal hearing. Like the results of other studies temporal bone fractures had a higher incidence of hearing loss as compared to other facial bone fractures.

In our study in India, Road traffic accidents (RTA) were the most common cause of Minor head injury. 75% of the RTA's were two wheeler accidents and none of them were wearing helmets at the time of accident. In about 40% of our patient's consumption of alcohol might have contributed to the road traffic accidents.

Only 10% of patients complained of hearing loss ,however on evaluation 62% were found to have hearing loss. The commonest type of hearing loss was sensorineural loss confined to high frequencies. The prognosis was poor if the hearing loss was more severe. The degree of hearing loss determined the outcome, and it was found in our study that patients who had moderate to severe hearing loss at the time of injury had a poorer prognosis. Temporal bone fractures have a higher incidence of hearing loss, the symptoms of vertigo was found to be 15%. Incidence of tinnitus is low after minor head injury. DPOAE assessment at 3000 Hz

Hearing Loss in Minor Head Injury 155

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449

and 4000 Hz is significant in assessing outer hair cell damage when compared to Pure Tone Audiometry in sub clinical hearing loss.

#### **8. Acknowledgements**

I wish to express my deep gratitude to Dr. John Mathew, Professor and Acting Head-unit-II, and Dr. Achamma Balraj, Professor Department of ENT, Christian Medical College Vellore, for their able guidance in conducting this study .

I wish to thank Dr. Anand Job, Medical superintendent, Professor and Head of unit-I, Department of ENT, and Dr. Pushparaj Singh, Head of Department of Accident and Emergency medicine for consent to use hospital facilities during the study period.

Last but not the least, I would like to thank my Parents, brother, wife, daughter, colleagues and staff of ENT for their help in making this study a reality.

I wish to thank Christoffel Blinden Mission SARO South for the financial support for Publication of this Chapter.

#### **9. References**


and 4000 Hz is significant in assessing outer hair cell damage when compared to Pure Tone

I wish to express my deep gratitude to Dr. John Mathew, Professor and Acting Head-unit-II, and Dr. Achamma Balraj, Professor Department of ENT, Christian Medical College Vellore,

I wish to thank Dr. Anand Job, Medical superintendent, Professor and Head of unit-I, Department of ENT, and Dr. Pushparaj Singh, Head of Department of Accident and

Last but not the least, I would like to thank my Parents, brother, wife, daughter, colleagues

I wish to thank Christoffel Blinden Mission SARO South for the financial support for

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Emergency medicine for consent to use hospital facilities during the study period.

Audiometry in sub clinical hearing loss.

for their able guidance in conducting this study .

and staff of ENT for their help in making this study a reality.

**8. Acknowledgements** 

Publication of this Chapter.

;1: 11-49

**9. References** 


**8** 

*Nigeria* 

**Conductive Hearing Loss Due to Trauma** 

Hearing impairment is one of the most frequent sensory deficits in humans, affecting more than 250 million people in the world. Consequences of hearing loss include inability to interpret speech, often resulting in a reduced ability to communicate and delay in language acquisition. Untreated hearing loss may also cause economic and educational disadvantage,

There are three basic types of hearing loss based on the part of auditory system with the

Conductive hearing loss is the most common cause of hearing impairment both in children and in the adults and the incidence is significantly higher in children. In conductive hearing loss, the inner ear functions normally, but sound vibrations are blocked from passage through the ear canal, ear drum or across the tiny bones located in the middle ear. Patients with conductive hearing loss hear perceive bone-conducted sounds presented with a small vibrator to the skull with better thresholds than sounds presented through earphones. Conductive hearing loss is usually mild to moderate in degree and can be unilateral or bilateral and in most cases unilateral. Most type of conductive hearing loss is correctable by relatively minor medical or surgical treatments. More significant conductive hearing loss may be associated

damage: conductive hearing loss, sensorineural hearing loss, and mixed hearing loss.

with skull and/or facial malformations which may require surgery for its correction.

Trauma generally is a major cause of morbidity and mortality in any society [Paul & Peter 2001]. Generally, trauma to the ear may result in fracture of the external auditory canal, tympanic membrane perforation, fracture to the ossicular chains, fracture of the temporal bone itself, damage to the cochlea or the facial nerve. Lesser bone trauma causes damage to the ossicular chains [Fradis & Podoshin 1975.] Hearing loss from trauma occurs in 22.5% of cases of temporal bone trauma and of these cases 16-30% have conductive hearing impairment [Fradis & Podoshin 1975, Ghoyareb B.Y et al 1987]. Hearing loss is defined as the averaged hearing loss at 1000, 2000 and 4000 Hz, measured by pure tone audiometry. This definition, although different from WHO/ISO definitions, is currently used in Nigeria because of its higher relevance to speech discrimination. It also corresponds to the standard proposed by the British Association of Otolaryngology and the British Society of Audiology (1983). Hearing is said to be impaired when the hearing level is above 25dB in the best ear. Hearing loss can have a profound impact on an individual's emotional, physical, and social well-being. People with hearing loss are more likely to report symptoms of depression,

**1. Introduction** 

social isolation and cause stigmatization.

Olushola A. Afolabi, Biodun S. Alabi,

Segun Segun-Busari and Shuaib Kayode Aremu *University of Ilorin Teaching Hospital, Ilorin, Kwara State* 

