title: The implications of physical injury on otovestibular and cognitive symptomatology following blast exposure.
abstract: OBJECTIVE
  Identify a potential difference in the spectrum of otovestibular and cognitive symptoms in blast-exposed patients comparing individuals with or without significant extremity injuries.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  A military tertiary care medical center.
  
  
  METHODS
  All new patient referrals for otovestibular evaluation after a blast injury or exposure were identified in the electronic medical record. One hundred consecutive patients meeting these criteria were studied. Data including presence of severe extremity injuries, diagnosis of mild traumatic brain injury, symptoms of imbalance, vertigo, headache, tympanic membrane perforation, hearing loss, and tinnitus were collected and analyzed.
  
  
  RESULTS
  Of 100 patients included, 38 suffered severe extremity injuries. Those patients with severe extremity injuries were more likely to suffer from tympanic membrane perforations (58% vs. 23%, P < .001, odds ratio [OR], 4.71, 95% confidence interval [CI], 1.96-11.33) and hearing loss (53% vs. 23%, P = .002, OR, 3.81, 95% CI, 1.59-9.11). However, those without severe extremity injuries were more likely to suffer from imbalance (79% vs. 32%, P < .001, OR, 8.17, 95% CI, 3.26-20.44) and vertigo (47% vs. 2%, P < .001, OR, 32.52, 95% CI, 4.19-252.07) and more likely to have been diagnosed with a mild traumatic brain injury following blast exposure (66% vs. 26%, P < .001, OR, 5.47, 95% CI, 2.24-13.36).
  
  
  CONCLUSIONS
  Blast-exposed individuals who sustained severe extremity injuries reported significantly fewer cognitive and vestibular symptoms. In the aftermath of a blast, those who can walk away may have still sustained a significant injury. Specifically, they may suffer more long-term cognitive and vestibular symptoms than those with severe physical injuries.
authors.affiliation: Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Johnson
authors.forename: Colleen F
authors.initials: CF
authors.lastname: Perez
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hoffer
mesh_terms: D001753:Blast Injuries / Q000175:diagnosis / Q000503:physiopathology*; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005121:Extremities / Q000293:injuries*; D006309:Hearing / Q000502:physiology; D034381:Hearing Loss / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008889:Military Personnel; D011379:Prognosis; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D015837:Vestibular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology
keywords: amputee; blast exposure; headache; hearing loss; traumatic brain injury; vertigo; vestibular disorder