Road traffic accidents (RTAs) are a significant public health concern globally, contributing to substantial morbidity and mortality. According to the World Health Organization, RTAs are projected to become the third leading cause of death by 2020, with low and middle-income countries bearing the brunt of this burden. In India, road traffic accidents account for approximately 2.5% of total deaths, with over 80,000 fatalities and more than 1.2 million injuries annually. The multifaceted nature of injuries sustained in RTAs necessitates a comprehensive understanding of the patterns and implications of these injuries, particularly those affecting the otorhinolaryngological (ENT) region [1,2].

ENT injuries resulting from road traffic accidents (RTAs) are complex and varied, often involving multiple delicate structures and are also potential for airway obstruction. Nasal fractures, the most common facial bone injury, account for approximately 40% of cases, with the nasal bone being the third most frequently fractured bone overall. Ear injuries, including pinna trauma and tympanic membrane perforations, are also prevalent. Laryngeal trauma, though less common, can lead to life-threatening airway compromise and requires prompt recognition and management. Facial fractures, particularly involving the frontal bone, are often associated with RTAs, with the anterior table commonly affected. The complexity of these injuries stems from the intricate anatomy of the ENT region, the potential for related injuries, and the need for a multidisciplinary approach to treatment, emphasizing the vulnerability of this area to trauma during vehicular collisions. [3-5]

The study reported that nasal bleeding, soft tissue injuries, and fractures of the nasal bone were frequently observed, indicating the critical role of otorhinolaryngologists in the trauma management team. Moreover, the demographic analysis of RTA victims often shows a male predominance, particularly among younger age groups, suggesting that certain populations are at higher risk for these types of injuries [6].

A variety of injuries are associated with RTAs, with traumatic brain injuries and lower-limb fractures being among the most prevalent. However, otorhinolaryngological injuries have received comparatively less attention despite their potential impact on morbidity. Research indicates that facial injuries, including fractures of the nasal bones and maxilla, are common in RTA victims, often necessitating surgical intervention and long-term rehabilitation. [7] Moreover, the relationship between GCS scores and the incidence of otorhinolaryngological injuries remains underexplored. Higher GCS scores typically indicate less severe head injury, yet the presence of concurrent ENT injuries can complicate the clinical picture and influence recovery trajectories. [8]  Timely and accurate diagnosis and treatment of ENT injuries resulting from trauma are crucial to preventing long-term complications, including airway obstruction, hearing loss, and facial deformities.[9] Prompt identification of injuries such as laryngeal trauma is essential, as delayed intervention can lead to significant airway compromise, potentially resulting in respiratory distress or failure. Similarly, injuries to the ear, such as tympanic membrane perforations and ossicular chain disruptions, can lead to permanent hearing loss if not appropriately managed. Additionally, facial fractures, particularly those involving the maxilla and mandible, require careful assessment and intervention to avoid malocclusion and aesthetic deformities that can affect a patient's quality of life.

The complexity of ENT injuries necessitates a multidisciplinary approach, involving otolaryngologists, maxillofacial surgeons, and audiologists, to ensure comprehensive care and optimal functional and cosmetic outcomes, underscoring the importance of early intervention in the management of these injuries. [9]  Furthermore, the implementation of preventive measures and public health strategies aimed at reducing the incidence of RTAs is crucial. Educational campaigns focusing on road safety, the importance of seatbelt use, and the dangers of distracted driving can significantly contribute to lowering the rates of accidents and, consequently, the associated ENT injuries.[10]

Therefore, this study aims to otorhinolaryngological manifestations of Road traffic accident patients. By revealing the patterns of injury and their correlation with head trauma severity

This cross-sectional study was conducted in the Department of Otorhinolaryngology, Tertiary Care Centre at Bhopal. All patients involved in road traffic accidents with Otorhinolaryngological injuries who visited the hospital during the study period and satisfy the selection criteria for the study. The total duration of the study was 18 months. This study utilized a sample size of 147 patients.  Ethical clearance was taken from the institutional ethical committee. Ethical Clearance letter is annexed.

Eligibility criteria:

1. Inclusion criteria:

• Trauma Patients of all age groups and all genders visiting OPD and Emergency department of Peoples Hospital

1. Exclusion criteria:

• Patients who do not consent to take part in the study.
• Patients with pre-existing otorhinolaryngological conditions unrelated to the road traffic accident.

Methodology

After obtaining written and informed consent, a detailed history and clinical examination were conducted, and findings were recorded in a proforma. Independent variables such as age, gender, occupation, religion, and marital status were collected alongside the dependent variables, which included injuries to the face, ear, nose, neck, and oral cavity. A thorough examination was performed on various anatomical regions: the face was assessed for abrasions, lacerations, crepitations, tenderness, and swelling; the ears were examined for conditions in the preauricular region, pinna, post-auricular region, external auditory canal, and tympanic membrane. The Glasgow Coma Scale (GCS) score was calculated based on eye response (spontaneous opening to verbal command or pain), motor response (obeying commands or localized pain), and verbal response (oriented or confused). The collected data were analysed to establish correlations between the severity of injuries and GCS scores.

Statistical analysis

Data was entered into Microsoft Excel version 17 and analysed utilizing Statistical Package for Social Sciences (SPSS). Descriptive format & diagrammatic presentation was done using bar diagram or pie chart as required. For descriptive analysis we used mean, standard deviation, ratio and proportion with percentage. The quantitative data, if required was analysed using independent student’s t test, p<0.05 was be considered as level of statistically significant.

Table-1: Cause/Occurrence of Road Traffic Accidents by Gender

The table 1 showed that self-falls from vehicles were the most common cause of road traffic accidents for both females (63.77%) and males (69.23%). Vehicle collisions accounted for 34.78% of female cases and 30.77% of male cases, while collisions were rare, with only one female case (1.45%) and no male cases.

Table-2: Fractures Distribution

The above table 2 showed that the most common fracture was maxillary, accounting for 68.7% (101 cases), followed by zygomatic fractures at 23.8% (35 cases). Le-Fort fractures were also common, with type 1 at 41.5% (61 cases), type 2 at 22.4% (33 cases), and type 3 at 4.8% (7 cases). Mandibular fractures included angle fractures (1.4%, 2 cases), body fractures (10.9%, 16 cases), and condylar fractures (20.4%, 30 cases). Parasymphysis fractures were seen in 5.4% (8 cases).

Table-3: Ear Examination Findings by Side

The above table 3 showed that the ear examination results for both sides. Preauricular lacerations were slightly more common on the left, while pinna lacerations were more frequent on the right. Both ears had similar levels of postauricular tenderness. The external auditory canal was mostly clear, with wax and clotted blood more common on the left. The tympanic membrane was intact in over 50% of cases, and hemotympanum was observed in both ears.

Table-4: GCS score Distribution.

The above table 4 showed that the following mean scores with their respective standard deviations (SD). The mean eye response score was 3.51 with a standard deviation of 0.51. The motor response had a mean of 5.47 and a standard deviation of 0.51. Lastly, the verbal response had a mean score of 5.34 with a standard deviation of 0.47.

Table 5:- Prevalence of Head Injury according to the GCS Score

Table 5 shows the Prevalence of Otorhinolaryngological Injuries according to the GCS Score. The GCS Score in Mild (13-15) had 89 cases, having Prevalence of 60.5%. The GCS Score in Moderate (9-12) had 56 cases, having Prevalence of 38.1%. The GCS Score in Severe (3-8) had 2 cases, having Prevalence of 1.4%.

The analysis of road traffic accident cause of road traffic accidents was self-fall from a vehicle, accounting for 66.7% of cases. Vehicle collisions were the second most 80 frequent cause, observed in 32.7% of cases, while direct collisions were relatively rare, comprising only 0.7% of incidents. These findings highlight the significant role of self-fall incidents in road traffic accidents, emphasizing the need for preventive measures such as improved road safety awareness and protective gear usage. Ravikumar R, et al., (2024) [11] reported that the most common mechanism of injury was skidding and falling from a two-wheeler, observed in 421 cases (42.1%). Similarly, Singh B, et al., (2023) [12] identified falls and assaults as the most frequent mechanisms of injury. In contrast, Singhai J, et al., (2018) [8] found that falls ranked as the third most common category of injury. Diallo MM, et al., (2024) [13] reported that motorcycle-to-motorcycle collisions were the most frequent cause of accidents, accounting for 31.32% of cases, followed by motorcycle skidding in 24.43% of cases. Additionally, Singh R, et al., (2023) [14] found that motorbike or scooter collisions with vehicles were the most prevalent, affecting 44.4% (115) of patients.

Facial examination findings revealed that tenderness was the most common presentation, observed in 112 cases (76%), and followed by swelling in 101 cases (69%). Abrasions were noted in 100 cases (68%), while lacerations were present in 44 cases (30%). Crepitations were the least frequent finding, occurring in 19 cases (13%). These findings highlight tenderness and swelling as the predominant clinical features among patients with facial injuries. Adoga AA et al., (2017) [15] reported that the most common facial examination findings were facial bone fractures (n = 37) and sutured facial lacerations (n = 5). Similarly, Singhai J, et al., (2018) [8] observed lacerations in 37 cases (18.5%) and abrasions in 22 cases (11%). In contrast, Sakthignanavel A, et al., (2022) [16] found that lacerations were the predominant finding, occurring in 23 cases (39.7%).

The distribution of facial fractures revealed that maxillary fractures were the most common, observed in 101 cases (68.7%), and followed by zygomatic fractures in 35 cases (23.8%). Among Le Fort fractures, type 1 was the most prevalent (41.5%), followed by type 2 (22.4%) and type 3 (4.8%). Mandibular fractures were primarily condylar (20.4%), with body fractures accounting for 10.9% and angle fractures being the least frequent (1.4%). Parasymphysis fractures were seen in 8 cases (5.4%). These findings highlight the predominance of maxillary and Le Fort fractures in facial trauma cases. Diallo MM, et al., (2024) [17] reported that maxillary fractures were observed in 2 cases (0.27%), while mandibular fractures were noted in 25 cases (3.43%). Similarly, Jarandikar AA, et al., (2020) [6] identified Le Fort fractures in two patients. Das B, et al., (2018) [18] found that nasal bone fractures were the most common nasal injury following road traffic accidents, accounting for 20% of cases. These findings highlight the variation in fracture patterns associated with facial trauma.

Ear examination findings revealed that preauricular and pinna lacerations were slightly more frequent on the left side, observed in 10 (6.8%) and 13 (8.8%) cases, respectively, compared to 9 (6.1%) and 16 (10.9%) cases on the right side. Postauricular tenderness was equally present on both sides in 14 cases (9.5%). The external auditory canal was clear in the majority of cases, with 99 (67.3%) on the right and 94 (63.9%) on the left. Clotted blood was observed in 19 (12.9%) right ears    and 17 (11.6%) left ears, while wax accumulation was slightly higher in the left ear (23.8%) than in the right (19.0%). Consistent with the findings of Mummidivarapu P, et al. (2023) [19] lacerations of the pinna were the most common ear injury, observed in 36 cases (45.0%). Lacerations accounted for the majority (45%) of all ear injuries, followed by tympanic membrane perforations (35%) and abrasions (23.7%). Complete ear avulsion was the least frequent, occurring in 11.2% of cases. Similarly, Jarandikar AA, et al., (2020) [6] reported ear manifestations in 8.3% of cases, including traumatic tympanic membrane perforations and lacerations in eight patients. Desai E, et al., (2022) [3] found that injuries involving the external ear were present in 16.3% of cases, external auditory canal injuries in 14.3%, and tympanic membrane involvement in 11.2%. These findings highlight the predominance of lacerations and tympanic membrane injuries in ear trauma following road traffic accidents.

The Glasgow Coma Scale (GCS) assessment revealed a mean eye response score of 3.51 ± 0.51, indicating preserved ocular responsiveness in most cases. The motor response had a mean score of 5.47 ± 0.51, reflecting a predominantly intact motor function. The verbal response score averaged 5.34 ± 0.47, suggesting that the majority of patients retained coherent speech abilities. These findings highlight the overall neurological status of the study population, with most patients exhibiting mild to moderate impairment. Alsharif R, et al., (2024) [20] reported that the Glasgow Coma Scale (GCS) assessment revealed a mean eye response score of 3 (±1.5), indicating preserved ocular responsiveness in most cases. The motor response had a mean score of 2 (±1.0), reflecting predominantly intact motor function, while the verbal response score averaged 2 (±1.0). Similarly, Diallo MM, et al., (2024) [17] analyzed the GCS distribution among 348 patients and found that the majority (80.46%) had mild head injury (GCS 13–15), while moderate head injury (GCS 9–12) was observed in 10.06% of cases. Severe head injury (GCS 3–8) was noted in 9.48% of patients, indicating that most individuals in the study had relatively preserved consciousness, with a smaller subset exhibiting significant neurological impairment.

Limitation: The study was conducted at a single tertiary care hospital, which may limit the generalizability of the findings to other healthcare settings. The number of patients included in the study may not be sufficient to represent the full spectrum of otorhinolaryngological manifestations in road traffic accident (RTA) patients. The study primarily focuses on initial presentations and lacks data on long-term outcomes and complications in RTA patients.

The present study highlights the epidemiological and clinical characteristics of road traffic accident (RTA) cases, emphasizing the high prevalence among young males and the significant burden of facial and skeletal injuries. The majority of RTA prevalence among males (53.1%). Among fractures, maxillary fractures (68.7%) were the most common, followed by zygomatic fractures (23.8%) and Le Fort type 1 fractures (41.5%). Mandibular fractures were also observed, with condylar fractures (20.4%) being the most frequently encountered. Ear examination findings revealed external auditory canal clotted blood in 12.9% of right ears and 11.6% of left ears. The presence of preauricular and pinna lacerations further highlighted the impact of trauma on the ear. These findings underscore the substantial burden of facial and skeletal injuries in RTA patients, particularly among young males, and emphasize the need for preventive measures, early diagnosis, and timely intervention to reduce morbidity and improve patient outcomes.

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