Otologic Outcomes After Blast Injury

Remenschneider, Aaron K.; Lookabaugh, Sarah; Aliphas, Avner; Brodsky, Jacob R.; Devaiah, Anand K.; Dagher, Walid; Grundfast, Kenneth M.; Heman‐Ackah, Selena E.; Rubín, S. del Villar; Sillman, Jonathon S.; Tsai, Angela C.; Vecchiotti, Mark A.; Kujawa, Sharon G.; Lee, Dong Hoon; Quesnel, Alicia M.

doi:10.1097/mao.0000000000000616

Cited by 82 publications

(42 citation statements)

References 28 publications

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“…Finally, the large pressures observed in this study suggest that hair cell loss in both the auditory (which is relatively common (45)) and vestibular systems should be expected; however, CI patients exhibiting these symptoms are seldom observed in the clinic. This disparity may result from a number of factors including: the transient nature of the pressures observed here, which are generally less damaging than an ongoing noise of comparable level; pre-existing hearing loss, which may mask new hearing loss; and the fact that vestibular injury is only seldom observed following blast exposure (46). …”

Section: Discussionmentioning

confidence: 92%

Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion

Greene

Mattingly

Hartl

et al. 2016

Otology &Amp; Neurotology

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Hypothesis Cochlear implant (CI) electrode insertion into the round window induces pressure transients in the cochlear fluid comparable to high intensity sound transients. Background Many patients receiving a CI have some remaining functional hearing at low frequencies, thus devices and surgical techniques have been developed to utilize this residual hearing. To maintain functional acoustic hearing, it is important to retain function of any hair cells and auditory nerve fibers innervating the basilar membrane; however, in a subset of patients, residual low frequency hearing is lost following CI insertion. Here, we test the hypothesis that transient intracochlear pressure spikes are generated during CI electrode insertion, which could cause damage and compromise residual hearing. Methods Human cadaveric temporal bones were prepared with an extended facial recess. Pressures in the scala vestibuli (PSV) and tympani (PST) were measured with fiber-optic pressure sensors inserted into the cochlea near the oval and round windows while CI electrodes (five styles from two manufacturers) were inserted into the cochlea via a round window approach. Results PST tended to be larger in magnitude than PSV, consistent with electrode insertion into the scala tympani. CI electrode insertion produced a range of pressure transients in the cochlea that could occur alone or as part of a train of spikes with equivalent peak sound pressure levels in excess of 170dB SPL. Instances of pressure transients varied with electrode styles. Conclusions Results suggest electrode design, insertion mechanism, and surgical technique affect the magnitude and rate of intracochlear pressure transients during CI electrode insertion. Pressure transients showed intensities similar to those elicited by high level sounds and thus could cause damage to the basilar membrane and/or hair cells.

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Section: Discussionmentioning

confidence: 92%

Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion

Greene

Mattingly

Hartl

et al. 2016

Otology &Amp; Neurotology

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“…Previous studies have analyzed definitive clinical data, whereas we have examined occupational hearing conservation screening data. Military and civilian otologic and audiometric outcome data are inherently different, primarily because of the putative penultimate circumstance of the blast [26].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported minimal sensorineural hearing loss in blast-exposed individuals [5][6][7][8][9]25]; however, reversible conductive hearing losses have been more consistently identified. The greatest source of information on symptoms immediately following primary blast injury of the ear may be found in civilian literature [26]. Blast injury among civilians, however, is uncommon and generally studied as a consequence of terrorism or industrial accidents.…”

Section: Introductionmentioning

confidence: 99%

Development of a comprehensive Blast-Related Auditory Injury Database (BRAID)

Joseph¹,

Horton

Clouser

et al. 2016

J Rehabil Res Dev

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Abstract-The Department of Defense Hearing ConservationProgram provides specific guidance for service components to prevent occupational hearing loss; however, it does not specifically contend with the unique noise exposures observed in the theater of war, such as blasts and explosions. In order to examine the effects of blast injury on hearing sensitivity, we developed a large database composed of demographic, audiometric, point of injury, and medical outcome data, with the primary aim of developing a long-standing and integrated capability for the surveillance, assessment, and investigation of blast-related hearing outcomes. Methods used to develop the dataset are described. Encompassing more than 16,500 Navy and Marine Corps personnel, the Blast-Related Auditory Injury Database (BRAID) includes individuals with a blast-related injury and nonblast control subjects. Using baseline and postdeployment hearing threshold data, a retrospective analysis of the cohort revealed that the rate of hearing loss for the injured servicemembers was 39%. The BRAID will be useful for studies that assess hearing patterns following deployment-related injury, such as blast exposures, that facilitate exploration of health outcomes and whether they are predictive of audiometric disposition and that help establish hearing loss prevention strategies and program policies for affected military commands and servicemembers.

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“…These patients should firstly be followed with regard to spontaneous recovery. Spontaneous closure of the perforation was found to be associated with its size, and this rate was reported to vary between 38% and 74% (7,11,12). In literature, standard tympanoplasty and, if required, tympanoossiculoplasty are the treatment methods for tympanic membrane perforations that develop after blast trauma and do not heal in the follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In literature, standard tympanoplasty and, if required, tympanoossiculoplasty are the treatment methods for tympanic membrane perforations that develop after blast trauma and do not heal in the follow-up. In patients undergoing surgery, the success rate of the graft after treatment is above 80% in many studies (7,10,11).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Otologic Injuries Due to Blast Trauma by Handmade Explosives

Aslıer

Ngy

2017

Turk Arch Otorhinolaryngol

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Objective: The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations. Methods:Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified.Results: Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed. Conclusion:Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma.

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Otologic Outcomes After Blast Injury

Abstract: Blast-related otologic injuries constitute a major source of ongoing morbidity after the Boston Marathon bombings. Continued follow-up and care of this patient population are warranted.

Cited by 82 publications

References 28 publications

Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion

Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion

Development of a comprehensive Blast-Related Auditory Injury Database (BRAID)

Analysis of Otologic Injuries Due to Blast Trauma by Handmade Explosives

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