Background Blast injuries in modern warfare are common, and the ear is often affected as it is an effective pressure transducer. This study aimed to evaluate military blast injuries of the ear.
Methods From May 2002 to October 2014, all patients referred to two military hospitals near Paris, France following exposure to massive explosions were analysed.
Results Among the 41 patients (82 ears), 36 of them reported tinnitus, 25 hearing loss, 14 earache and 8 vertigo. It was noted that 44% of the patients had tympanic membrane perforations and that this was bilateral in two-thirds of the cases. The hearing loss in 29% of the cases was pure sensorineural, in 55% it was mixed and in 15% it was a pure conductive hearing loss. There was no correlation between the impact of middle ear lesions and the severity of the inner ear injury. Three patients had a pharyngolaryngeal blast injury detected on the battlefield associated with blast lung injury, but only two of them had tympanic perforations. Nine tympanoplasty procedures were performed, of which 44% succeeded in sealing the perforation.
Conclusions Blast injuries of the ear are characterised by significant functional signs and are not correlated to otoscopic examinations. Sensorineural hearing loss is almost immediately final. When deciding on initial management, the status of the tympanic membrane does not provide any information about the risk of a primary blast injury of the lung; laryngeal nasofibroscopy seems a more relevant screening test.
- tympanic membrane perforation
- hearing loss
- inner ear
- Received October 18, 2016.
- Revision received December 27, 2016.
- Accepted January 11, 2017.
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Contributors SBdR planned the study, drafted the article, submitted the study, and gave final approval of the version to be published and agreement to be accountable for all aspects of the work. AC planned the study and conducted the survey, did the acquisition of data, the analysis and interpretation of data, and gave final approval of the version to be published and agreement to be accountable for all aspects of the work. OM did the analysis and interpretation of data, drafted the article, and gave final approval of the version to be published and agreement to be accountable for all aspects of the work. QL and SM realised the literature review, did the acquisition of data, and gave final approval of the version to be published and agreement to be accountable for all aspects of the work. YP did the critical revision of the article for important intellectual content, and gave final approval of the version to be published and agreement to be accountable for all aspects of the work.
Disclaimer This article is based on the medical thesis of Dr Anna Crambert, which has been published commercially as ‘Blast auriculaires aerians par explosion’. The data have not previously been published as an academic paper.
Competing interests None declared.
Ethics approval Scientific Committee for Clinical Trials of the Percy Hospital, February 2011.
Provenance and peer review Not commissioned; externally peer reviewed.
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