Acute temporal bone trauma: Utility of high-resolution computed tomography

Objective: To determine the clinical utility of high-resolution computed tomography (HRCT) for temporal bone trauma evaluation and management. Study Design: Retrospective review. Setting: Level I trauma center. Patients: Patients (n = 105) with evidence of temporal bone trauma. Main Outcome Measures: Statistically significant associations between HRCT, clinical, audiometric, and head CT findings, and management decisions; role of HRCT in management decisions. Results: Statistical analysis demonstrated poor association between specific clinical and HRCT findings, and between HRCT findings and management decisions. The HRCT complemented decision making in 10% of cases and revealed asymptomatic carotid canal fractures in 9% Of cases. Conclusion: Routine HRCT yields minimal clinical utility. Selective use of HRCT may complement decision making, but patient management is predominantly influenced by other factors. Although angiography was performed in cases of asymptomatic carotid canal fractures, no clinical utility for this practice was demonstrated. An algorithm for temporal bone trauma evaluation and management is presented.