Blast injury to the ear: management and long term follow up at a tertiary care hospital in a terrorism affected area of North India
Keywords:Blast trauma, Tympanic membrane, Hearing loss, Tympanoplasty, Steroids
Background: A large proportion of blast victims suffers ear injuries; however, these injuries are often overlooked.
Methods: We assessed 411 blast victims to detect ear injury employing detailed history, otological examination, pure tone audiometry, auditory steady state response and distortion product otoacoustic emissions. TM perforations were managed by thorough cleaning of ear by suctioning, edges approximation and gelfoam splinting in group A and only suctioning in group B. Prednisolone in tapering doses was prescribed for managing hearing loss in all except those in whom it was contraindicated.
Results: Out of 411 blast victims, 228 (55.47%) had aural trauma. All cases were males (being serving soldiers) between ages of 21 and 57 years. (Mean 37.77 years, SD 10.38). 285 ears had a perforated TM. Of these, 145 were assigned to group A while 140 were in group B. There was no significant difference in spontaneous healing of perforation between the two groups but at 5 years’ follow up group A had significantly higher number of unscarred, healthy TMs than group B (Z score=2.2111, p=0.0271). Mean pure tone average was 51.16 dB (SD 8.79 dB) at presentation and 38.91 dB (SD 7.86 dB) at 5 years. Recovery of SNHL component was significantly better in steroid treated patients.
Conclusions: Edges approximation and gelfoam splinting helped in reducing scarring of TM on healing, on long follow up. Steroid treated group showed better recovery of hearing loss.
Luo H, Jiang S, Nakmali DU, Gan RZ, Lu H. Mechanical Properties of a Human Eardrum at High Strain Rates After Exposure to Blast Waves. J Dynamic Behavior Mater. 2016;2:59–73.
Wolf SJ, Bebarta VS, Bonnett CJ. Blast injuries. Lancet. 2009;374:405–15.
Joseph AR, Shaw JL, Clouser MC, MacGregor AJ, Galarneau MR. Impact of blast injury on hearing in a screened male military population. Am J Epidemiol. 2018;187(1):7–15.
Fausti SA, Wilmington DJ, Gallun FJ, Myers PJ, Henry JA. Auditory and vestibular dysfunction associated with blast-related traumatic brain injury. J Rehab Res Develop. 2009;46(6):797-810.
Ianov IK, Gofman VR, Glaznikov LA, Maksimova TG. Clinical and statistical patterns of the hearing system lesions caused by explosive mine trauma. Voen Med Zh. 2001;322(9):32-7.
Persaud R, Hajioff D, Wareing M, Chevretton E. Otological trauma resulting from the Soho Nail Bomb in London, April 1999. Clin Otolaryngol 2003;28(3):203-6.
Ritenour AE, Wickley A, Ritenour JS. Tympanic Membrane Perforation and Hearing Loss From Blast Overpressure in Operation Enduring Freedom and Operation Iraqi Freedom Wounded. J Trauma Injury, Infection, Critical Care. 2008;64:2:174–7.
Remenschneider AK, Lookabaugh S, Aliphas A, Brodsky JR, Devaiah AK, Dagher W, et al. Otologic Outcomes After Blast Injury: The Boston Marathon Experience. Otol Neurotol. 2014;35(10):1825-34.
Raju G. Disability evaluation in acoustic blast trauma. Indian J Occup Environ Med. 2015;19(3):138–40.
Shah A, Ayala M, Capra G, Fox D, Hoffer M. Otologic assessment of blast and nonblast injury in returning Middle East-deployed service members. Laryngoscope. 2014;124(1):272–7.
Ballivet de Régloix S, Crambert A, Maurin O, Lisan Q, Marty S, Pons Y. Blast injury of the ear by massive explosion: a review of 41 cases. J Royal Army Med Corps. 2017;163:333-8.
Klamkam P, Jaruchinda P, Nivatwongs S, Muninnobpamasa T, Harnchumpol P, Nirattisai S, Moungthong G. Otologic manifestations from blast injuries among military personnel in Thailand. American J Otolaryngol Head Neck Med Surg. 2013;34:287–91.
Wani A, Rehman A, Lateef S,Malik R, Ahmed A, Ahmad W, et al. Traumatic tympanic membrane perforation: An overview. Indian J Otol. 2016;22:100-4.
Sridhara SK, Rivera A, Littlefield P. Tympanoplasty for Blast-Induced Perforations :The Walter Reed Experience. Otolaryngol Head Neck Surg. 2013;148(1):103-7.
Orji FT, Agu CC. Determinants of spontaneous healing in traumatic perforations of the tympanic membrane. Clin Otolaryngol. 2008;33:420‑6.
Cohen JT, Ziv G, Bloom J, Zikk D, Rapoport Y, Himmelfarb MZ. Blast injury of the ear in a confined space explosion: auditory and vestibular evaluation. Isr Med Assoc J. 2002;4(7):559-62.
Jalilvand H. Effects of blast and acoustic trauma: assessment of hearing status on war veterans. ENT Audiol News. 2014;23:3:61- 4.
Pusz, M D, Robitschek, J. Traumatic Hearing Loss in the Context of Blast-Related Tympanic Membrane Perforation. Military Med. 2017;182(1):1645-8.
Cho S-I, Gao SS, Xia A, Wang R, Salles FT, et al. Mechanisms of Hearing Loss after Blast Injury to the Ear. PLoS ONE 2013;8(7):e67618.
Chait, RH, Casler J, Zajtchuk JT. Blast injury to the ear: historical perspective. Ann Otol Rhinol Laryngol Suppl. 1989;140:9 –11.
Noam Y, Nir F, Manor S, Tal M. Acute Acoustic Trauma among Soldiers during an Intense Combat. J Am Acad Audiol. 2017;28(5):436-43.
Patterson JH Jr, Hamernik RP. Blast overpressure induced structural and functional changes in the auditory system. Toxicology. 1997;121(1):29-40.
Niwa K, Mizutari K, Matsui T et al. Pathophysiology of the inner ear after blast injury caused by laser induced shock wave. Sci Rep. 2016;6:31754.