Blast Injury- Auditory System

Background

  • Most common inj seen
  • May indicate possibility of pulmonary injury
    • Indicates high pressure wave struck casualty
    • Suggest CXR, observation , possible CT of chest
    • Actual correlation now questioned

Pathophysiology

  • Damage to middle & inner ear
    • Isolated tympanic membrane rupture most common
    • Hemotympanum without rupture
    • Ossicle fracture / dislocation
  • Due to overpressure from blast wave
  • Sensorineural hearing loss can occur
    • Infection
    • Ototoxic ear drops

Diagnostics

  • Symptoms
    • Hearing loss, tinnitus
    • Ear pain, bloody fluid
  • Physical Exam
    • Routine otoscopy
    • Otomicroscopy for small perforations
    • See also TM injury staging
  • Diagnostic Testing
    • Middle-ear impedence testing
    • Audiometry

Treatment

  • Most perforations heal spontaneously
  • Tympanic rupture: remove debris, irrigate canal
    • See also treatment by severity
  • Perform primary closure if >1/3 of membrane damaged
    • Outpatient treatments
      • Cautery paper patch
      • Fat plug tympanoplasty
      • Irritant oil
    • Operating room techniques
      • Tympanoplasty >90% effective
  • No specific therapy for sensorineural acoustic trauma
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