Skip to main content Accessibility help
×
Home

Otologic Considerations of Blast Injury

  • D. Spencer Darley and Robert M. Kellman

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)

Copyright

Corresponding author

Correspondence: Address correspondence and reprint requests to Dr D. Spencer Darley, Department of Otolaryngology and Communication Disorders, Upstate Medical University.

References

Hide All
1.Zuckerman, S.Experimental study of blast injuries to the lungs. Lancet. 1940;2:219224(Level 4).
2.Born, CT.Blast trauma: the fourth weapon of mass destruction. Scand J Surg. 2005;94:279285(Level 4).
3.Arnold, JL, Halpern, P, Tsai, M, Smithline, H.Mass casualty terrorist bombings: a comparison of outcomes by bombing type. Ann Emerg Med. 2004;43:263273(Level 5).
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.
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;422:8287(Level 4).
6.Wightman, J, Gladish, S.Explosions and blast injuries. Ann Emerg Med. 2001;37:664678(Level 4).
7.Chaloner, E.Blast injury in enclosed spaces. BMJ. 2005;331:119120 (Level 5).
8.Sasser, SM, Sattin, RW, Hunt, RC, Krohmer, J.Blast lung injury. Prehosp Emerg Care. 2006;10:165172(Level 5).
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).
10.Mellor, SG.The relationship of blast loading to death and injury from explosion. World J Surg. 1992;16:893898(Level 4).
11.Clemedson, CJ, Jonsson, A.Distribution of extra- and intrathoracic pressure variations in rabbits exposed to air shock waves. Acta Physiol Scand. 1962;54:1829(Level 5).
12.Cooper, GJ, Taylor, DE.Biophysics of impact injury to chest and abdomen. J R Army Med Corps. 1989;135:5867(Level 5).
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;134:946952(Level 4).
14.DePalma, RG, Burris, DG, Champion, HR, Hodgson, MJ.Blast injuries. N Engl J Med. 2005;352:13351342(Level 5).
15.Liebovici, D, Gofrit, ON, Shapira, SC.Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med. 1999;34:168172(Level 2).
16.Stien, M, Hirshberg, A.Medical consequences of terrorism. The conventional weapon threat. Surg Clin North Am. 1999;79:15371552(Level 5).
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;4:559562(Level 4).
18.Sprem, N, Branica, S, Dawidowsky, K.Tympanoplasty after war blast lesions of the eardrum: retrospective study. Croat Med J. 2001;42:642645(Level 2).
19.Garth, RJN.Blast injury of the ear: an overview and guide to management. Injury. 1995;26:363366(Level 5).
20.Kerr, AG, Byrne, JET.Concussive effects of bomb blast on the ear. J Laryngol Otol. 1975;89:131143(Level 4).
21.Richmond, DR, Fletcher, ER, Yelverton, JT, Phillips, YY.Physical correlates of eardrum rupture. Ann Otol Rhinol Laryngol. 1989;98:3541(Level 4).
22.Zalweski, T.Expierimentelle untersuchungen über die resistenzfahigkeit des trommelfells. Z Ohrenheilkd. 1906;52:109128(Level 2).
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).
24.Hirsch, FG.Effects of overpressure on the ear—a review. Ann NY Acad Sci. 1968;152:146162(Level 5).
25.White, CS, Bowen, IG, Richmond, DR.The relation between eardrum failure and blast induced pressure variations. Space Life Sci. 1970;2:158205(Level 5).
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).
27.Pahor, AL.The ENT problems following the Burmingham bombings. J Laryngol Otol. 1981;95:399406(Level 4).
28.Singh, D, Ahluwalia, KJS.Blast injuries of the ear. J Laryngol Otol. 1968;82:1017(Level 4).
29.Chandler, DW, Edmond, CV.Effects of blast overpressure on the ear: case reports. J Am Acad Audol. 1997;8:8188(Level 4).
30.Seaman, RW, Newell, RC.Another etiology of middle ear cholesteatoma. Arch Otolaryngol. 1971;94:440442(Level 4).
31.Kronenberg, J, Ben-Shoshan, J, Modan, M, Leventon, G.Blast injury and cholesteatoma. Am J Otol. 1988;9:127130(Level 2).
32.Miller, ISM, McGahey, D, Law, K.The otologic consequences of the Omaha bomb disaster. Otol Head Neck Surg. 2002;126:127128(Level 4).
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).
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):2334(Level 5).
35.Miladick, RA, Carraway, JH.Ear reattachment by modified pocket principle. Clin Plastic Surg. 1978;51:584587(Level 4).
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:S51S56(Level 4).
37.Gapany-Gapanavicius, B, Brama, I, Chisin, R.Early repair of blast ruptures of the tympanic membrane. J Laryngol Otol. 1977;91:565573(Level 4).
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;85.1:1324(Level 5).
39.Cope, D, Bova, R.Steroids in otolaryngology. Laryngoscope. 2008;118:15561560(Level 4).
40.Durrat, I, Ahmad, N, Seidman, K, Seidman, MD.Auditory research involving antioxidants. Curr Opin Otol. 2007;15:358363(Level 5).
41.Argyros, GJ.Management of primary blast injury. Toxicology. 1997;121:105115(Level 5).
42.Melinek, M, Naggan, L, Altman, M.Acute acoustic trauma, a clinical investigation and prognosis in 433 symptomatic soldiers. Isr J Med Sci. 1976;12:562569(Level 4).
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;119:450454(Level 2).

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed