Otologic manifestations from blast injuries among military personnel in Thailand

[Blast and explosion traumas-effects on the middle and inner ear based on the example of Bundeswehr foreign missions]

Despite all protective measures, blast and explosion traumas are a frequent pattern of injury in Bundeswehr missions abroad. Due to body protection measures, head injuries, particularly of the ears, are higher in number compared to injuries in other regions of the body. Perforations of the tympanic membrane are the most frequent lesions of the middle ear, acute sensorineural hearing loss is the most frequent lesion of the inner ear, often accompanied by tinnitus and dizziness. With a high spontaneous recovery rate, prompt specialist care for these injuries is provided according to medical standards comparable to those in the home country.

Otologic Injuries Secondary to Explosive Attack

The frequency of injuries secondary to terrorist attack explosion is globally increasing. Like any other country, our country experienced multiple suicide bombings in recent years. Otologic injuries may be observed after these kinds of attacks. Considering otologic complaints are well known medical results of explosion attacks, routine otologic evaluation in the first examining hospital-even in case of no relevant complaint- is crucial for establishing causal relation in following forensic medicine evaluation. In this study, 33 cases from 6 suicide bomber attacks in 4 different incidents that happened in Turkey were evaluated for otologic injuries. Two out of three patients were not evaluated for otologic injuries in their first hospital visit. It was considered that 8 cases had a loss of hearing and 9 cases had tympanic membrane rupture secondary to the explosion. Complaints such as hearing loss and tinnitus very often after a bomb attack, we saw that 22 of 33 included patients did not have an ear nose, and throat examination at the time of the incident. In this kind of attack, there can be various life-threatening injuries and therefore relatively less important evaluations such as ENT examination can often be overlooked.

Comparison of the demographic and clinical characteristics, functional status and quality of life of lower extremity amputees to identify the reason for undergoing amputation

OBJECTIVE

The aim of the study was to evaluate and compare clinical and demographic characteristics, functional status and quality of life among patients who underwent amputation for the most common reason in our region.

METHODS

Demographic data, level of and reasons for undergoing amputation and clinical data on the use of prostheses in 126 patients were recorded. The amputees were divided into three groups: vascular, trauma and landmine. Variables related to clinical and demographic characteristics, daily life activities and quality of life were investigated. Duration of prosthesis use, daily walking distance with prosthesis, 10-m walking speed with the prosthesis and 6-min walking distance of the amputees were recorded. The Short Form-36, Turkish version of the Trinity Amputation and Prosthesis Experience Scales and Beck Depression Inventory were used to evaluate the patients' quality of life. The residual limb pain scale was used to evaluate the severity of pain.

RESULTS

Comparison between the amputees in the trauma and vascular groups showed highly significant results (P< 0.001) in amputees in the trauma group with respect to all parameters of daily life activities, functional status and quality of life. Comparison between the vascular and landmine amputees showed significant results (P< 0.001) in the landmine amputees with respect to all parameters except emotional role functioning, social functioning and mental health. Comparison between the amputees in the trauma and landmine groups showed no significant results (P> 0.05) with respect to all parameters expect emotional role functioning and mental health.

CONCLUSIONS

While the clinical and demographic characteristics, functional status and quality of life parameters were similar in the amputees in the trauma and landmine groups, they showed statistically significant differences in almost all parameters compared with those in vascular amputees.

Analysis of Otologic Injuries Due to Blast Trauma by Handmade Explosives

Objective

The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations.

Methods

Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified.

Results

Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed.

Conclusion

Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma.

Demographic Properties of Civilians with Blast Injuries in Southeastern Anatolia Region

Objectives

The present study conducted demographic analysis of blast injuries, with the authors aiming to guide the determination of groups and regions at risk, helping hospitals take preventive measures and providing information for accurate triage, rapid intervention, multidisciplinary approach, and lowering workforce losses.

Methods

This study retrospectively examined the demographic properties of civilians who presented to the Emergency Department of Dicle University after being injured in explosions of various origins between January 2005 and September 2013 in the Southeastern Anatolia Region of Turkey.

Results

Of the study population, 85.50% were male and 14.50% were female. The explosive responsible for injury was a mine in 20.51% of the cases, a bomb in 29.06%, a squib in 14.53%, dynamite in 7.69%, and some other explosive in the remaining 28.31%. Of those injured, 35.90% were students, 21.36% were farmers, 11.10% were shepherds or drivers, and 31.62% were from other occupational groups.

Conclusions

In conclusion, injuries resulting from explosions are associated with higher morbidity and mortality rates, making it necessary to increase the number of trauma centers and emergency action teams in that region, as well as demining the region and educating the native population about explosives.

Noise-induced hearing loss: a military perspective

PURPOSE OF REVIEW

To summarize relevant literature occurring over the past 12-18 months forwarding understanding of noise-induced hearing loss in relation to military service.

RECENT FINDINGS

Hearing loss prior to entry into military service is highly predictive of subsequent hearing loss and hearing loss disability. Tightly controlled organic solvent exposure may not be a significant risk factor for noise-induced hearing loss. Increasingly detailed analysis of high intensity noise, impulse and blast noise exposures, and the methods used to mitigate these exposures are leading to breakthroughs in understanding and predicting hearing loss in military service.

SUMMARY

Prevention, mitigation, treatment, and prediction of the effects of hazardous noise exposure in military service continue to require a multidisciplinary team of individuals from around the world fully aware of the detrimental effect to service members and their societies of hearing loss disability.