Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-27T14:53:05.202Z Has data issue: false hasContentIssue false
  • English
  • Français

Otologic Considerations of Blast Injury

Published online by Cambridge University Press:  08 April 2013

D. Spencer Darley  and
Robert M. Kellman
Get access Rights & Permissions [Opens in a new window]

Abstract

The ear by design is exquisitely sensitive to barotrauma. As a result, it is typically the first organ affected in primary blast injury. The most common symptoms encountered include hearing loss, ringing, and drainage. In severe cases, the highest priority is appropriately directed toward diagnosis and treatment of life-threatening injuries; however, injury to the ear is missed frequently. With simple screening procedures, limited management, and appropriate otolaryngologic referral, acute and long-term morbidity can be averted for both critical and noncritical patients. The article provides an overview of blast mechanics and pathophysiology. It details various blast-related injuries to the external, middle, and inner ear. Standard of care assessment and management strategies are presented for acute and late otologic sequelae of the blast-injured patient.

(Disaster Med Public Health Preparedness. 2010;4:145-152)

Keywords

blast injuriesearhearing disorderstympanic membrane perforationvestibular disorderstraumawounds and injuriesreview articlesear, middleterrorism
Type
Review Articles
Information
Disaster Medicine and Public Health Preparedness , Volume 4 , Issue 2 , June 2010 , pp. 145 - 152
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Zuckerman, S.Experimental study of blast injuries to the lungs. Lancet. 1940;2:219–224(Level 4).Google Scholar
2.Born, CT.Blast trauma: the fourth weapon of mass destruction. Scand J Surg. 2005;94:279–285(Level 4).CrossRefGoogle ScholarPubMed
3.Arnold, JL, Halpern, P, Tsai, M, Smithline, H.Mass casualty terrorist bombings: a comparison of outcomes by bombing type. Ann Emerg Med. 2004;43:263–273(Level 5).CrossRefGoogle ScholarPubMed
4.Oxford Centre for Evidence-based Medicine. Levels of Evidence and Grades of Recommendation. http://www.cebm.net/index.aspx?o=1025. Published March 2009. Accessed April 10, 2009.Google Scholar
5.Langworthy, M, Sabra, J, Gould, M.Terrorism and blast phenomena: lessons learned from the attack on the USS Cole (DDG67). Clin Orthop Relat Res. 2004;422:82–87(Level 4).Google Scholar
6.Wightman, J, Gladish, S.Explosions and blast injuries. Ann Emerg Med. 2001;37:664–678(Level 4).Google Scholar
7.Chaloner, E.Blast injury in enclosed spaces. BMJ. 2005;331:119–120 (Level 5).CrossRefGoogle ScholarPubMed
8.Sasser, SM, Sattin, RW, Hunt, RC, Krohmer, J.Blast lung injury. Prehosp Emerg Care. 2006;10:165–172(Level 5).CrossRefGoogle ScholarPubMed
9.Stuhmiller, JH, Phillips, YY, Richmond, DR.The physics and mechanisms of primary blast injury. In: Bellamy RF, Zajtchuk R, eds. Conventional Warfare: Ballistic, Blast and Burn Injuries. Washington, DC: Office of the Surgeon General of the US Army; 1991:241-270 (Level 5).Google Scholar
10.Mellor, SG.The relationship of blast loading to death and injury from explosion. World J Surg. 1992;16:893–898(Level 4).Google Scholar
11.Clemedson, CJ, Jonsson, A.Distribution of extra- and intrathoracic pressure variations in rabbits exposed to air shock waves. Acta Physiol Scand. 1962;54:18–29(Level 5).CrossRefGoogle ScholarPubMed
12.Cooper, GJ, Taylor, DE.Biophysics of impact injury to chest and abdomen. J R Army Med Corps. 1989;135:58–67(Level 5).Google Scholar
13.Mrena, R, Paakkonen, R, Back, L, Pirvola, U.Otologic consequences of blast exposure: a Finnish case study of a shopping mall bomb explosion. Acta Otolaryngol. 2004;134:946–952(Level 4).CrossRefGoogle Scholar
14.DePalma, RG, Burris, DG, Champion, HR, Hodgson, MJ.Blast injuries. N Engl J Med. 2005;352:1335–1342(Level 5).CrossRefGoogle ScholarPubMed
15.Liebovici, D, Gofrit, ON, Shapira, SC.Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med. 1999;34:168–172(Level 2).Google Scholar
16.Stien, M, Hirshberg, A.Medical consequences of terrorism. The conventional weapon threat. Surg Clin North Am. 1999;79:1537–1552(Level 5).Google Scholar
17.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;4:559–562(Level 4).Google Scholar
18.Sprem, N, Branica, S, Dawidowsky, K.Tympanoplasty after war blast lesions of the eardrum: retrospective study. Croat Med J. 2001;42:642–645(Level 2).Google ScholarPubMed
19.Garth, RJN.Blast injury of the ear: an overview and guide to management. Injury. 1995;26:363–366(Level 5).CrossRefGoogle ScholarPubMed
20.Kerr, AG, Byrne, JET.Concussive effects of bomb blast on the ear. J Laryngol Otol. 1975;89:131–143(Level 4).CrossRefGoogle Scholar
21.Richmond, DR, Fletcher, ER, Yelverton, JT, Phillips, YY.Physical correlates of eardrum rupture. Ann Otol Rhinol Laryngol. 1989;98:35–41(Level 4).CrossRefGoogle Scholar
22.Zalweski, T.Expierimentelle untersuchungen über die resistenzfahigkeit des trommelfells. Z Ohrenheilkd. 1906;52:109–128(Level 2).Google Scholar
23.Blake, PM, Douglas, JBW, Krohn, PL, Zuckerman, S.Rupture of the Ear-Drums by Blast. Ministry of Home Security Report BPC 43/169/WS21, Military Personnel Research Committee (Medical Research Council). Oxford, UK: Department of Human Anatomy, Oxford University; undated. (Level 2).Google Scholar
24.Hirsch, FG.Effects of overpressure on the ear—a review. Ann NY Acad Sci. 1968;152:146–162(Level 5).CrossRefGoogle ScholarPubMed
25.White, CS, Bowen, IG, Richmond, DR.The relation between eardrum failure and blast induced pressure variations. Space Life Sci. 1970;2:158–205(Level 5).Google Scholar
26.James, DJ, Pickett, VC, Burdett, KJ, Cheesman, A.The Response of the Human Ear to Blast. Part 1: The Effect on the Ear Drum of a Short Duration, Fast Rising Pressure Wave. AWRE/CDE report no. 04/82, London, Ministry of Defense Procurement Office, 1982, p 1-47.8 (Level 2).Google Scholar
27.Pahor, AL.The ENT problems following the Burmingham bombings. J Laryngol Otol. 1981;95:399–406(Level 4).Google Scholar
28.Singh, D, Ahluwalia, KJS.Blast injuries of the ear. J Laryngol Otol. 1968;82:1017(Level 4).CrossRefGoogle ScholarPubMed
29.Chandler, DW, Edmond, CV.Effects of blast overpressure on the ear: case reports. J Am Acad Audol. 1997;8:81–88(Level 4).Google Scholar
30.Seaman, RW, Newell, RC.Another etiology of middle ear cholesteatoma. Arch Otolaryngol. 1971;94:440–442(Level 4).Google Scholar
31.Kronenberg, J, Ben-Shoshan, J, Modan, M, Leventon, G.Blast injury and cholesteatoma. Am J Otol. 1988;9:127–130(Level 2).Google Scholar
32.Miller, ISM, McGahey, D, Law, K.The otologic consequences of the Omaha bomb disaster. Otol Head Neck Surg. 2002;126:127–128(Level 4).Google Scholar
33.Hamernik, RP, Turrentine, G, Roberto, M, Salvi, R, Henderson, D.Anatomical correlates of impulsive noise induced damage in the cochlea. Hear Res. 1984;13:229(Level 5).Google Scholar
34.Roberto, M, Hamernik, RP, Turrentine, GA.Damage of the auditory system associated with acute blast trauma. Ann Otol Rhinol Laryngol. 1989;98(suppl 140):23–34(Level 5).Google Scholar
35.Miladick, RA, Carraway, JH.Ear reattachment by modified pocket principle. Clin Plastic Surg. 1978;51:584–587(Level 4).Google Scholar
36.Roland, PS, Stewart, MG, Hannley, M.Consensus panel on role of potentially ototoxic antibiotics for topical middle ear use: introduction, methodology, and recommendations. Otol Head Neck Surg. 2004;130:S51–S56(Level 4).Google Scholar
37.Gapany-Gapanavicius, B, Brama, I, Chisin, R.Early repair of blast ruptures of the tympanic membrane. J Laryngol Otol. 1977;91:565–573(Level 4).CrossRefGoogle ScholarPubMed
38.Cripps, NP, Glover, MA, Guy, RJ.The pathophysiology of primary blast injury and its implications for treatment. Part II: the auditory structures and abdomen. J R Nav Med Serv. 1999;85.1:13–24(Level 5).Google Scholar
39.Cope, D, Bova, R.Steroids in otolaryngology. Laryngoscope. 2008;118:1556–1560(Level 4).CrossRefGoogle ScholarPubMed
40.Durrat, I, Ahmad, N, Seidman, K, Seidman, MD.Auditory research involving antioxidants. Curr Opin Otol. 2007;15:358–363(Level 5).Google Scholar
41.Argyros, GJ.Management of primary blast injury. Toxicology. 1997;121:105–115(Level 5).Google Scholar
42.Melinek, M, Naggan, L, Altman, M.Acute acoustic trauma, a clinical investigation and prognosis in 433 symptomatic soldiers. Isr J Med Sci. 1976;12:562–569(Level 4).Google Scholar
43.Herdman, SJ, Tusa, RJ, Zee, DS, Proctor, LR, Mattox, DE.Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg. 1993;119:450–454(Level 2).Google Scholar