title: Tympanoplasty Outcomes for Blast-Induced Perforations from Iraq and Afghanistan.
abstract: Objective To describe characteristics of blast-induced tympanic membrane perforations that do not spontaneously heal, evaluate the outcomes of tympanoplasty techniques, and understand the factors associated with surgical success. Setting Two tertiary military health care institutions. Study Design Case series with chart review. Subjects and Methods This study reviewed the practice of 1 military neurotologist and included all tympanoplasties for combat blast-induced perforations from 2007 to 2012, which comprised a total of 55 patients. Surgical outcomes and associated perioperative factors were examined to include size, location, bilateral involvement, timing of surgery, and surgical technique. Results Fifty-five patients (68 ears) met inclusion criteria. Thirty-six (53%) were total or near-total perforations, and 51% of patients had bilateral perforations. The overall success rate was 77%. It was 82% for lateral grafts and 70% for medial grafts, but the difference between these was not statistically significant. Age was a significant factor, with a success rate of 56% for ages 25 to 34 years, compared with 90% for 20 to 24 and >34 years. Patients who had bilateral sequential tympanoplasties also had lower success rates than those who had only unilateral surgery (62% vs 87%, P = .002). Ossicular disruptions were found in 5 ears, and cholesteatoma was discovered in 8. Surgical timing did not predict success, as the average time until repair was 153 days in successful cases and 151 days in failures. The mean conductive hearing improvement was 13.6 dB, and there were no major complications. Conclusion Tympanoplasty can be challenging in this population. Age and bilateral surgery were the only independent variables that showed significance.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Sungjin A
authors.initials: SA
authors.lastname: Song
authors.affiliation: 2 Department of Otolaryngology, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA.
authors.forename: Shankar K
authors.initials: SK
authors.lastname: Sridhara
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Littlefield
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018058:Tympanic Membrane Perforation / Q000209:etiology* / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*
keywords: blast induced; perforations; tympanoplasty