title: Tympanoplasty for blast-induced perforations: the Walter Reed experience.
abstract: OBJECTIVE
  To review our tympanoplasty results for blast-induced tympanic membrane perforations and evaluate the association of various clinical factors with surgical success.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Two tertiary military healthcare institutions.
  
  
  METHODS
  This is a retrospective review of all patients who had nonrevision tympanoplasty during a 1-year period for blast-induced perforations by the 2 neurotologists at Walter Reed Army Medical Center and National Naval Medical Center. Various perioperative clinical factors were analyzed for relations to successful perforation closure, the need for a second operation, and postoperative hearing.
  
  
  RESULTS
  Thirty-four patients met inclusion criteria. All were male, and the average age was 24.0 years. Twenty-two (65%) were total or near-total perforations, of which 12 (35%) were repaired using lateral graft technique. The remainder had various medial graft procedures. Ossicular abnormalities were found in 6 (18%) patients. Cholesteatoma was discovered in 3 (9%) patients. Closure was complete in 82% of patients. The incomplete closures were with large perforations, those with foreign bodies (shrapnel), and in 1 with postoperative water exposure. There were no major complications, and the mean conductive hearing improvement was 11.3 dB.
  
  
  CONCLUSIONS
  Blast-induced tympanic membrane perforations are common in our population of wounded warriors. These cases are challenging because most have total or near-total perforations, the ossicles can be out of place, the blast itself can implant epithelium in the middle ear, and foreign bodies can create a hostile middle ear environment. However, given attention to detail, we found that standard tympanoplasty techniques work well.
authors.affiliation: Walter Reed National Military Medical Center, Department of Otolaryngology Head & Neck Surgery, Bethesda, Maryland 20889, USA.
authors.forename: Shankar K
authors.initials: SK
authors.lastname: Sridhara
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Rivera
authors.forename: Philip
authors.initials: P
authors.lastname: Littlefield
mesh_terms: D000328:Adult; D001299:Audiometry / Q000379:methods; D001301:Audiometry, Pure-Tone; D001753:Blast Injuries / Q000150:complications* / Q000601:surgery; D018424:Cholesteatoma, Middle Ear / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult