title: Blast injury of the ear by massive explosion: a review of 41 cases.
abstract: BACKGROUND
  Blast injuries in modern warfare are common, and the ear is often affected as it is an effective pressure transducer. This study aimed to evaluate military blast injuries of the ear.
  
  
  METHODS
  From May 2002 to October 2014, all patients referred to two military hospitals near Paris, France following exposure to massive explosions were analysed.
  
  
  RESULTS
  Among the 41 patients (82 ears), 36 of them reported tinnitus, 25 hearing loss, 14 earache and 8 vertigo. It was noted that 44% of the patients had tympanic membrane perforations and that this was bilateral in two-thirds of the cases. The hearing loss in 29% of the cases was pure sensorineural, in 55% it was mixed and in 15% it was a pure conductive hearing loss. There was no correlation between the impact of middle ear lesions and the severity of the inner ear injury. Three patients had a pharyngolaryngeal blast injury detected on the battlefield associated with blast lung injury, but only two of them had tympanic perforations. Nine tympanoplasty procedures were performed, of which 44% succeeded in sealing the perforation.
  
  
  CONCLUSIONS
  Blast injuries of the ear are characterised by significant functional signs and are not correlated to otoscopic examinations. Sensorineural hearing loss is almost immediately final. When deciding on initial management, the status of the tympanic membrane does not provide any information about the risk of a primary blast injury of the lung; laryngeal nasofibroscopy seems a more relevant screening test.
authors.affiliation: Department of ENT-Head and Neck Surgery, Military Training Hospital Percy, Clamart, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Ballivet de Régloix
authors.affiliation: Department of ENT-Head and Neck Surgery, Military Training Hospital Val de Grâce, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Crambert
authors.affiliation: Emergency Department, Fire Fighting Brigade of Paris, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Maurin
authors.affiliation: Department of ENT-Head and Neck Surgery, Military Training Hospital Percy, Clamart, France.
authors.forename: Q
authors.initials: Q
authors.lastname: Lisan
authors.affiliation: Department of ENT-Head and Neck Surgery, Military Training Hospital Percy, Clamart, France.
authors.forename: S
authors.initials: S
authors.lastname: Marty
authors.affiliation: Department of ENT-Head and Neck Surgery, Military Training Hospital Percy, Clamart, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Pons
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000453:epidemiology*; D004423:Ear / Q000293:injuries*; D005107:Explosions; D005260:Female; D005602:France; D034381:Hearing Loss / Q000453:epidemiology*; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D014012:Tinnitus; D018058:Tympanic Membrane Perforation / Q000453:epidemiology*; D055815:Young Adult
keywords: blast; hearing loss; inner ear; tympanic membrane perforation