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Debenham L, Khan N, Nouhan B, Muzaffar J. A systematic review of otologic injuries sustained in civilian terrorist explosions. Eur Arch Otorhinolaryngol 2024; 281:2223-2233. [PMID: 38189970 DOI: 10.1007/s00405-023-08393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Determine the prevalence of otological symptoms and tympanic membrane perforation, healing rates of tympanic membrane perforation with surgical and conservative management, and hearing function in civilian victims of terrorist explosions. METHODS A systematic review was conducted with searches on Medline, Embase, EMCare and CINAHL for publications between the 1st January 1945 and 26th May 2023. Studies with quantitative data addressing our aims were included. This review is registered with PROSPERO: CRD42020166768. Among 2611 studies screened, 18 studies comprising prospective and retrospective cohort studies were included. RESULTS The percentage of eardrums perforated in patients admitted to hospital, under ENT follow up and attending the emergency department is 69.0% (CI 55.5-80.5%), 38.7% (CI 19.0-63.0%, I2 0.715%) and 21.0% (CI 11.9-34.3%, I2 0.718%) respectively. Perforated eardrums heal spontaneously in 62.9% (CI 50.4-73.8%, I2 0.687%) of cases and in 88.8% (CI 75.9-96.3%, I2 0.500%) of cases after surgery. Common symptoms present within one month of bombings are tinnitus 84.7% (CI 70.0-92.9%, I2 0.506%), hearing loss 83.0% (CI 64.5-92.9%, I2 0.505%) and ear fullness 59.7% (CI 13.4-93.4%, I2 0.719). Symptomatic status between one and six months commonly include no symptoms 57.5% (CI 46.0-68.3%), hearing loss 35.4% (CI 21.8-51.8%, I2 0.673%) and tinnitus 15.6% (CI 4.9-40.0%, I2 0.500%). Within one month of bombings, the most common hearing abnormality is sensorineural hearing loss affecting 26.9% (CI 16.9-40.1%, I2 0.689%) of ears 43.5% (CI 33.4-54.2%, I2 0.500) of people. CONCLUSION Tympanic membrane perforation, subjective hearing loss, tinnitus, ear fullness and sensorineural hearing loss are common sequelae of civilian terrorist explosions.
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Affiliation(s)
- Luke Debenham
- University of Warwick, University of Warwick Medical School, Coventry, UK.
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, UK.
| | - Naairah Khan
- University of Warwick, University of Warwick Medical School, Coventry, UK
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, UK
| | | | - Jameel Muzaffar
- Department of Ear Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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2
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Kislov M, Chauhan M, Krupin K, Kildyushov E, Zotkin D. Forensic pathological characteristics of explosion trauma in confined space terrorist mass fatalities classified with a 3-dimensional model. Leg Med (Tokyo) 2022; 58:102090. [DOI: 10.1016/j.legalmed.2022.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
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3
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Denny JW, Dickinson AS, Langdon GS. Defining blast loading 'zones of relevance' for primary blast injury research: A consensus of injury criteria for idealised explosive scenarios. Med Eng Phys 2021; 93:83-92. [PMID: 34154779 DOI: 10.1016/j.medengphy.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/23/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Blast injuries remain a serious threat to defence and civilian populations around the world. 'Primary' blast injuries (PBIs) are caused by direct blast wave interaction with the human body, particularly affecting air-containing organs. Work to define blast loading conditions for injury research has received relatively little attention, though with a continued experimental focus on PBIs and idealised explosion assumptions, meaningful test outcomes and subsequent clinical applications, rely on appropriate simulated conditions. This paper critically evaluates and combines existing PBI criteria (grouped into those affecting the auditory system, pulmonary injuries and brain trauma) as a function of idealised blast wave parameters. For clinical blast injury researchers, analysis of the multi-injury criteria indicates zones of appropriate loading conditions for human-scale test items and demonstrates the importance of simulating blast conditions that are both realistic and relevant to the injury type. For certain explosive scenarios, spatial interpretation of the 'zones of relevance' could support emergency response and hazard preparedness by informing triage, patient management and resource allocation, thus leading to improved health outcomes. This work will prove useful to clinical blast injury researchers, blast protection engineers and clinical practitioners involved in the triage, diagnosis, and treatment of PBIs.
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Affiliation(s)
- J W Denny
- Department of Mechanical Engineering, University of Southampton, Southampton, SO17 1BJ, UK.
| | - A S Dickinson
- Department of Mechanical Engineering, University of Southampton, Southampton, SO17 1BJ, UK
| | - G S Langdon
- Department of Civil and Structural Engineering, University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK; Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa
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4
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Joseph AR, Shaw JL, Clouser MC, MacGregor AJ, Dougherty AL, Galarneau MR. Clinical audiometric patterns of hearing loss following blast-related injury in U.S. military personnel. Int J Audiol 2020; 59:772-779. [PMID: 32293926 DOI: 10.1080/14992027.2020.1743884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To identify clinical audiometric patterns of hearing loss following blast-related injury (BRI) in US military personnel.Design: Retrospective cohort study.Study sample: A total of 1186 male Navy and Marine Corps service members with normal hearing thresholds on pre-injury audiograms who had post-injury audiograms in the Blast-Related Auditory Injury Database.Results: Low- and high-frequency pure-tone averages (PTAs) were significantly higher in those with BRI than non-blast-related injury (NBRI) for both ears (p < 0.001 for all comparisons). Overall, 172 (15%) service members met criteria for post-injury hearing loss and were categorised into PTA or single-frequency hearing loss subgroups. PTA hearing loss was more common in the BRI group (50% vs. 33%, p < 0.036), whereas single-frequency hearing loss was more common in the NBRI group. Most hearing loss was mild to moderate in degree, and three distinct audiometric patterns emerged (i.e. flat, sloping and rising). A flat pattern was the most prevalent configuration among those with PTA hearing loss, especially bilateral loss. Single-frequency hearing loss was mostly unilateral and high frequency.Conclusions: In this study, BRI produced hearing loss across test frequencies, generating more clinically actionable post-injury audiograms than NBRI. We found that post-injury audiometric patterns of hearing loss among military personnel may vary.
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Affiliation(s)
- Antony R Joseph
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, IL, USA
| | - Jaime L Shaw
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Mary C Clouser
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Michael R Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA
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5
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, the affilitaed Yiwu Hospital, Yiwu city, Zhejiang provice, China
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6
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Abstract
PURPOSE OF REVIEW The incidence of blast injuries has increased, and the ear is the highest risk organ. Ear injury induced by blast exposure is important in both military and civilian conditions. The permanent hearing loss caused by blast exposure is associated with a decline in the quality of life. In this review, I describe recent therapeutic strategies for each of the ear pathologies caused by blast exposure. RECENT FINDINGS For tympanic membrane perforation after blast exposure, basic fibroblast growth factor (bFGF) has been used as a less invasive treatment to repair the tympanic membrane. The closure rates of tympanic membrane perforations treated with bFGF were reported to be comparable to those following conventional tympanoplasty.For sensorineural hearing loss after blast exposure, treatment with neurotrophic factors, such as nerve growth factor (NGF) or neurotrophin-3, antioxidants, and Atoh1 induction have recently been applied, and some of them were considered for clinical application. SUMMARY Recent advances of therapeutics for blast-induced hearing loss, based on their pathologies, have been outlined. There are several promising therapeutic approaches for both middle and inner ear disorders after blast exposure; however, further research is needed to establish new treatments for blast-induced hearing dysfunction.
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Xie P, Peng Y, Hu J, Peng A, Yi S. Assessment of hearing loss induced by tympanic membrane perforations under blast environment. Eur Arch Otorhinolaryngol 2019; 277:453-461. [PMID: 31691016 DOI: 10.1007/s00405-019-05710-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSES This study provides an approach to estimating tympanic membrane perforation-induced hearing loss (HL) using a human middle ear model. METHODS Sixty-one cases of tympanic membrane perforation originating from fireworks were reported from the Ear-Nose-Throat Department. The otoscope, audiometry data and diagnosis records were organized, and gender, age, etiology, perforation size and diseased ear side were classified as independent variables. A multinomial regression model was used to analyze the potential effects of the variables on HL. Meanwhile, a human middle ear model was implemented to calculate the ensued HL resulting from different perforation areas and sites. In addition, linear regression models were used to establish functions between perforation size and HL. RESULTS The audiometry data indicate that HL at high frequencies (f > 2 kHz) is much more profound than that at the speech frequency band (f < 1 kHz). Compared with mild HL (<15 dB), mediate HL (15-30 dB) was correlated with the perforation area (p < 0.05, 95% CI), while severe HL (>30 dB) was affected by both perforation size and age (p < 0.05, 95% CI). However, other factors, including gender and diseased ear side, do not show a statistically significant effect on HL. Furthermore, the Kruskal-Wallis test result reveals that HL at frequencies of 0.25 kHz ≤ f ≤ 8 kHz is strongly associated with the perforation size (p < 0.05, 95% CI). CONCLUSIONS It is conclusive that HL is positively proportional to the perforation size. However, HL is not correlated with the perforation site for small perforation areas of < 10% (p > 0.05, 95% CI).
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Affiliation(s)
- Pengpeng Xie
- Key Laboratory of Traffic Safety On Track, Ministry of Education, School of Traffic and Transportation Engineering, Central South University, Changsha, China.,Joint International Research Laboratory of Key Technology for Rail Traffic Safety, Central South University, Changsha, China
| | - Yong Peng
- Key Laboratory of Traffic Safety On Track, Ministry of Education, School of Traffic and Transportation Engineering, Central South University, Changsha, China. .,National and Local Joint Engineering Research Center of Safety Technology for Rail Vehicle, Central South University, Changsha, China.
| | - Junjiao Hu
- Department of of RadiologyThe Second Xiangya Hospital, Central South University, Changsha, China
| | - Anquan Peng
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shengen Yi
- Research Laboratory of Hepatobiliary Diseases General Surgical Department, The Second Xiangya Hospital, Central South University, Changsha, China
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Abstract
OBJECTIVE After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients. STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. PATIENTS Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included. INTERVENTION All included patients were treated with systemic corticosteroid therapy, concurrent hyperbaric oxygen therapy (HBOT) was advised to each and every included patient. MAIN OUTCOME MEASURES Participants underwent a routine otologic work-up including otoscopy, liminal audiometry, and subjective outcome measures related to tinnitus at baseline and at follow-up. Primary outcome was to describe the otologic morbidity after acute acoustic trauma (AAT). Secondary outcome was to evaluate the recovery of hearing loss, subjective symptoms, and tympanic membrane perforations. RESULTS Fifty-six patients were included in our population with an average age of 27 ± 13 years, and 46% women/54% men. Thirty-two patients reported subjective hearing loss, 45 reported tinnitus, 45 reported a feeling of pressure in the ear, 2 patients experienced vertigo, and 18 patients reported hyperacusis. Otoscopic examination revealed three tympanic membrane perforation (TMP). Sensorineural hearing loss (SNHL) was observed in 41% (n = 23) and mixed hearing loss in 3.6% (n = 2). No conductive hearing loss (CHL) was observed. Follow-up was obtained in 76.8%, with the last follow-up available at 47 ± 74 days. Two perforations closed spontaneously, while one persistent perforation was successfully reconstructed with complete air-bone gap closure. There was a significant improvement in subjective symptoms. SNHL improvement was observed in 52.6% (10/19), mixed hearing loss improved in both patients. Improvement in hearing thresholds was seen in patients treated with steroids and in those treated with steroids and HBOT, there was no significant difference in the degree of improvement between these two groups. CONCLUSIONS Blast-related otologic injuries have a significant impact on morbidity. Comprehensive otologic evaluation and state-of-the-art treatment may lead to a significant improvement in symptoms and hearing loss.
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9
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Zhang J. Blast-induced tinnitus: Animal models. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:3811. [PMID: 31795642 DOI: 10.1121/1.5132551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Blast-induced tinnitus is a prevalent problem among military personnel and veterans, as blast-related trauma damages the vulnerable microstructures within the cochlea, impacts auditory and non-auditory brain structures, and causes tinnitus and other disorders. Thus far, there is no effective treatment of blast-induced tinnitus due to an incomplete understanding of its underlying mechanisms, necessitating development of reliable animal models. This article focuses on recent animal studies using behavioral, electrophysiological, imaging, and pharmacological tools. The mechanisms underlying blast-induced tinnitus are largely similar to those underlying noise-induced tinnitus: increased spontaneous firing rates, bursting, and neurosynchrony, Mn++ accumulation, and elevated excitatory synaptic transmission. The differences mainly lie in the data variability and time course. Noise trauma-induced tinnitus mainly originates from direct peripheral deafferentation at the cochlea, and its etiology subsequently develops along the ascending auditory pathways. Blast trauma-induced tinnitus, on the other hand, results from simultaneous impact on both the peripheral and central auditory systems, and the resultant maladaptive neuroplasticity may also be related to the additional traumatic brain injury. Consequently, the neural correlates of blast-induced tinnitus have different time courses and less uniform manifestations of its neural correlates.
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Affiliation(s)
- Jinsheng Zhang
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4201 Saint Antoine, Detroit, Michigan 48201, USA
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10
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Lou ZC, Wei H, Lou ZH. Pretreatment factors affecting traumatic tympanic membrane regeneration therapy using epidermal growth factor. Am J Otolaryngol 2018; 39:711-718. [PMID: 30078511 DOI: 10.1016/j.amjoto.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The use of epidermal growth factor (EGF) to achieve closure of human traumatic tympanic membrane perforations (TMPs) was recently reported. However, pretreatment factors affecting healing outcomes have seldom been discussed. This study was performed to evaluate pretreatment factors contributing to the success or failure of TMP healing using EGF. DESIGN AND PARTICIPANTS This was a retrospective cohort study of 95 TMPs who were observed for at least 6 months after EGF treatment. Eleven factors considered likely to affect healing outcome were evaluated by univariate and multivariate logistic regression analyses. INTERVENTIONS Each traumatic TMP was treated by daily topical application of EGF. The main outcome measures were complete closure versus failure to close and mean closure time. RESULTS A total of 95 patients were included in the analyses. The total closure rate was 92.6% at 6 months, and the mean closure time was 10.5 ± 4.8 days. The closure rate was not significantly different according to the duration of perforation ≤3 days and >3 days (P = 0.816). However, the mean closure time was significantly different according to the duration of perforation (P < 0.001). The perforation size did not affect the closure rate (P = 0.442). The mean closure time in the low-dose EGF group was significantly shorter than that in the high-dose EGF group (P = 0.001). Logistic regression analyses showed that perforations with preexisting myringosclerosis were more likely to fail to close compared to those without preexisting myringosclerosis (P = 0.001). Multivariate logistic regression analyses showed that the duration of perforation (P = 0.011), size of perforation (P < 0.001), and involvement of the malleus in perforation (P = 0.005) were factors independently correlated with closure time. CONCLUSIONS Daily application of EGF can be used to treat all traumatic TMPs. The size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dosage was sufficient to keep the eardrum moist. Multivariate logistic regression analyses revealed a significant correlation between preexisting myringosclerosis and failure to heal. Nevertheless, the size of perforation, starting time of application, and malleus injury were independent prognostic factors for prolonged healing time.
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Affiliation(s)
- Zheng-Cai Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang 322000, China.
| | - Hong Wei
- Department of Ophthalmology, West China Hospital Sichuan University, Sichuan, 610000, China.
| | - Zi-Han Lou
- Department Clinical Class No.11, Clinical Medicine, Xinxiang Medical University, Henan 453003, China.
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11
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Hickman TT, Smalt C, Bobrow J, Quatieri T, Liberman MC. Blast-induced cochlear synaptopathy in chinchillas. Sci Rep 2018; 8:10740. [PMID: 30013117 PMCID: PMC6048130 DOI: 10.1038/s41598-018-28924-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/02/2018] [Indexed: 12/29/2022] Open
Abstract
When exposed to continuous high-level noise, cochlear neurons are more susceptible to damage than hair cells (HCs): exposures causing temporary threshold shifts (TTS) without permanent HC damage can destroy ribbon synapses, permanently silencing the cochlear neurons they formerly activated. While this "hidden hearing loss" has little effect on thresholds in quiet, the neural degeneration degrades hearing in noise and may be an important elicitor of tinnitus. Similar sensory pathologies are seen after blast injury, even if permanent threshold shift (PTS) is minimal. We hypothesized that, as for continuous-noise, blasts causing only TTS can also produce cochlear synaptopathy with minimal HC loss. To test this, we customized a shock tube design to generate explosive-like impulses, exposed anesthetized chinchillas to blasts with peak pressures from 160-175 dB SPL, and examined the resultant cochlear dysfunction and histopathology. We found exposures that cause large >40 dB TTS with minimal PTS or HC loss often cause synapse loss of 20-45%. While synaptopathic continuous-noise exposures can affect large areas of the cochlea, blast-induced synaptopathy was more focal, with localized damage foci in midcochlear and basal regions. These results clarify the pathology underlying blast-induced sensory dysfunction, and suggest possible links between blast injury, hidden hearing loss, and tinnitus.
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Affiliation(s)
- T T Hickman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA.
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA.
| | - C Smalt
- Bioengineering Systems and Technologies, MIT Lincoln Laboratory, Lexington, MA, 02421, USA
| | - J Bobrow
- Bioengineering Systems and Technologies, MIT Lincoln Laboratory, Lexington, MA, 02421, USA
| | - T Quatieri
- Bioengineering Systems and Technologies, MIT Lincoln Laboratory, Lexington, MA, 02421, USA
| | - M C Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
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12
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De Cauwer H, Somville FJMP. Neurological disease in the aftermath of terrorism: a review. Acta Neurol Belg 2018; 118:193-199. [PMID: 29694644 DOI: 10.1007/s13760-018-0924-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
The purpose of our review is to discuss current knowledge on long-term sequelae and neurological disorders in the aftermath of a terrorist attack. The specific aspects of both psychological and physical effects are mentioned in more detail in this review. Also, the outcomes such as stress-related disorders, cardiovascular disease, and neurodegenerative disease are explained. Moreover, PTSD and posttraumatic structural brain changes are a topic for further investigations of the patients suffering from these attacks. Not only the direct victims are prone to the after effects of the terroristic attacks, but the rescue workers, physicians, witnesses and worldwide citizens may also be affected by PTSD and other neurological diseases as well. The determination of a whole series of risk factors for developing neurological disorders can be a means to set up early detection, preventative measures, to refine treatment and thus to gain better outcome in the future.
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Affiliation(s)
- Harald De Cauwer
- Department of Neurology, AZ St Dimpna Regional Hospital, JB Stessenstraat 2, 2440, Geel, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Francis J M P Somville
- Department of Emergency Medicine, Dimpna Regional Hospital, Geel, Belgium
- Department of Health Psychology, University of Leiden, Leiden, The Netherlands
- Clerkships Office, Faculty of Medicine, University of Leuven, Leuven, Belgium
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13
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Joseph AR, Shaw JL, Clouser MC, MacGregor AJ, Galarneau MR. Impact of Blast Injury on Hearing in a Screened Male Military Population. Am J Epidemiol 2018; 187:7-15. [PMID: 29309519 DOI: 10.1093/aje/kwx199] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
Abstract
Exposure to hazardous intensity levels of combat noise, such as blast, may compromise a person's ability to detect and recognize sounds and communicate effectively. There is little previous examination of the onset of hearing health outcomes following exposure to blast in representative samples of deployed US military personnel. Data from the prospective Blast-Related Auditory Injury Database were analyzed. We included only those participants with qualified hearing tests within a period of 12 months prior to, and following, injury (n = 1,574). After adjustment for relevant covariates and potential confounders, those who sustained a blast injury had significantly higher odds of postinjury hearing loss (odds ratio = 2.21; 95% confidence interval: 1.42, 3.44), low-frequency hearing loss (odds ratio = 1.95; 95% confidence interval: 1.01, 3.78), high-frequency hearing loss (odds ratio = 2.45; 95% confidence interval: 1.43, 4.20), and significant threshold shift compared with a group with non-blast-related injury. An estimated 49% of risk for hearing loss in these blast-injured, deployed military members could be attributed to the blast-related injury event. This study reinforced that it is imperative to identify at-risk populations for early intervention and prevention, as well as to consistently monitor the effects of blast injury on hearing outcomes.
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Affiliation(s)
- Antony R Joseph
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California
| | - Jaime L Shaw
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California
| | - Mary C Clouser
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California
| | - Michael R Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California
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14
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Ouyang J, Pace E, Lepczyk L, Kaufman M, Zhang J, Perrine SA, Zhang J. Blast-Induced Tinnitus and Elevated Central Auditory and Limbic Activity in Rats: A Manganese-Enhanced MRI and Behavioral Study. Sci Rep 2017; 7:4852. [PMID: 28687812 PMCID: PMC5501813 DOI: 10.1038/s41598-017-04941-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 04/27/2017] [Indexed: 02/06/2023] Open
Abstract
Blast-induced tinitus is the number one service-connected disability that currently affects military personnel and veterans. To elucidate its underlying mechanisms, we subjected 13 Sprague Dawley adult rats to unilateral 14 psi blast exposure to induce tinnitus and measured auditory and limbic brain activity using manganese-enhanced MRI (MEMRI). Tinnitus was evaluated with a gap detection acoustic startle reflex paradigm, while hearing status was assessed with prepulse inhibition (PPI) and auditory brainstem responses (ABRs). Both anxiety and cognitive functioning were assessed using elevated plus maze and Morris water maze, respectively. Five weeks after blast exposure, 8 of the 13 blasted rats exhibited chronic tinnitus. While acoustic PPI remained intact and ABR thresholds recovered, the ABR wave P1-N1 amplitude reduction persisted in all blast-exposed rats. No differences in spatial cognition were observed, but blasted rats as a whole exhibited increased anxiety. MEMRI data revealed a bilateral increase in activity along the auditory pathway and in certain limbic regions of rats with tinnitus compared to age-matched controls. Taken together, our data suggest that while blast-induced tinnitus may play a role in auditory and limbic hyperactivity, the non-auditory effects of blast and potential traumatic brain injury may also exert an effect.
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Affiliation(s)
- Jessica Ouyang
- Department of Otolaryngology and Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Edward Pace
- Department of Otolaryngology and Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Laura Lepczyk
- Department of Otolaryngology and Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Michael Kaufman
- Department of Otolaryngology and Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Jessica Zhang
- Department of Otolaryngology and Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Shane A Perrine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Jinsheng Zhang
- Department of Otolaryngology and Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
- Department of Communication Sciences & Disorders, Wayne State University College of Liberal Arts and Sciences, Detroit, MI, 48201, USA.
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15
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Keller M, Sload R, Wilson J, Greene H, Han P, Wise S. Tympanoplasty following Blast Injury. Otolaryngol Head Neck Surg 2017; 157:1025-1033. [DOI: 10.1177/0194599817717486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To assess outcomes following tympanoplasty for blast-induced tympanic membrane perforations in a military population. Study Design Case series with chart review. Setting Tertiary care medical centers. Subjects and Methods Military personnel (N = 254) undergoing tympanoplasty for blast-related tympanic membrane perforations sustained between April 2005 and July 2014 were identified from the Expeditionary Medical Encounter Database. Descriptive statistics were obtained regarding demographics, primary and revision surgery success rates, hearing status pre- and postsurgery, and frequency of ossicular reconstruction. Rates of successful perforation closure were assessed against perforation size and character (central vs marginal) and time to surgery. Rates and types of complications were additionally explored. Results There were a total of 352 operations among 254 subjects, with an 82.1% rate of successful closure following primary surgery. For successful primary tympanoplasty, the mean improvement in pure tone average was 11.7 ± 12.1 dB. Ossiculoplasty was performed in 9.1% (32 of 352) of cases. There was no significant relationship between successful perforation closure and perforation size, perforation character, or time between injury and surgery. Cholesteatoma complicated 4.3% (15 of 352) of cases. A significant relationship was identified between risk of cholesteatoma development and increasing perforation size and marginal perforations. Conclusion Tympanoplasty success rates for blast-induced tympanic membrane perforations are lower than for other common injury mechanisms. Due to appreciable rates of postoperative cholesteatoma development, close clinical surveillance is recommended.
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Affiliation(s)
- Matthew Keller
- Department of Otolaryngology–Head and Neck Surgery, Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
| | - Ryan Sload
- Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Justin Wilson
- Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Howard Greene
- Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Peggy Han
- Naval Health Research Center, San Diego, California, USA
| | - Sean Wise
- Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
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Lou X. It is important to measure changes in the bone-conduction threshold when evaluating whether FGF-2 can be used to repair blast-induced total or near-total tympanic membrane perforations. Am J Otolaryngol 2017; 38:267-268. [PMID: 28132727 DOI: 10.1016/j.amjoto.2017.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Xudan Lou
- Department of Otorhinolaryngology Operating Theatre (OR), Yiwu Central Hospital, Yiwu City, Zhejiang Province, China.
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Ballivet de Régloix S, Crambert A, Maurin O, Lisan Q, Marty S, Pons Y. Blast injury of the ear by massive explosion: a review of 41 cases. J ROY ARMY MED CORPS 2017; 163:333-338. [DOI: 10.1136/jramc-2016-000733] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/27/2016] [Accepted: 01/11/2017] [Indexed: 11/03/2022]
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Song SA, Sridhara SK, Littlefield PD. Tympanoplasty Outcomes for Blast-Induced Perforations from Iraq and Afghanistan: 2007-2012. Otolaryngol Head Neck Surg 2016; 156:353-359. [DOI: 10.1177/0194599816677693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sungjin A. Song
- Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Shankar K. Sridhara
- Department of Otolaryngology, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Philip D. Littlefield
- Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
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Joseph AR, Horton JL, Clouser MC, MacGregor AJ, Louie M, Galarneau MR. Development of a comprehensive Blast-Related Auditory Injury Database (BRAID). ACTA ACUST UNITED AC 2016; 53:295-306. [DOI: 10.1682/jrrd.2015.02.0031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/21/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | - Jaime L. Horton
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA
| | - Mary C. Clouser
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA
| | - Andrew J. MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA
| | - Michelle Louie
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA
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Lunze FI, Lunze K, Tsorieva ZM, Esenov CT, Reutov A, Eichhorn T, Offergeld C. Global surgery in a postconflict setting--5-year results of implementation in the Russian North Caucasus. Glob Health Action 2015; 8:29227. [PMID: 26498745 PMCID: PMC4620685 DOI: 10.3402/gha.v8.29227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 11/20/2022] Open
Abstract
Background Collaborations for global surgery face many challenges to achieve fair and safe patient care and to build sustainable capacity. The 2004 terrorist attack on a school in Beslan in North Ossetia in the Russian North Caucasus left many victims with complex otologic barotrauma. In response, we implemented a global surgery partnership between the Vladikavkaz Children's Hospital, international surgical teams, the North Ossetian Health Ministry, and civil society organizations. This study's aim was to describe the implementation and 5-year results of capacity building for complex surgery in a postconflict, mid-income setting. Design We conducted an observational study at the Children's Hospital in Vladikavkaz in the autonomous Republic of North Ossetia-Alania, part of the Russian Federation. We assessed the outcomes of 15 initial patients who received otologic surgeries for complex barotrauma resulting from the Beslan terrorism attack and for other indications, and report the incidence of intra- and postoperative complications. Results Patients were treated for trauma related to terrorism (53%) and for indications not related to violence (47%). None of the patients developed peri- or postoperative complications. Three patients (two victims of terrorism) who underwent repair of tympanic perforations presented with re-perforations. Four junior and senior surgeons were trained on-site and in Germany to perform and teach similar procedures autonomously. Conclusions In mid-income, postconflict settings, complex surgery can be safely implemented and achieve patient outcomes comparable to global standards. Capacity building can build on existing resources, such as operation room management, nursing, and anesthesia services. In postconflict environments, substantial surgical burden is not directly attributable to conflict-related injury and disease, but to health systems weakened by conflicts. Extending training and safe surgical care to include specialized interventions such as microsurgery are integral components to strengthen local capacity and ownership. Our experience identified strategies for fair patient selection and might provide a model for potentially sustainable surgical system building in postconflict environments.
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Affiliation(s)
- Fatima I Lunze
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Health for the Caucasus e.V., Cottbus, Germany
| | - Karsten Lunze
- Health for the Caucasus e.V., Cottbus, Germany.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA;
| | - Zemfira M Tsorieva
- Department of Surgery, Vladikavkaz Children's Hospital, Vladikavkaz, Russian Federation
| | - Constantin T Esenov
- Department of Surgery, Vladikavkaz Children's Hospital, Vladikavkaz, Russian Federation
| | - Alexandr Reutov
- Ministry of Health North Ossetia, Vladikavkaz, Russian Federation.,Federal Hospital Beslan, Beslan, Russian Federation
| | - Thomas Eichhorn
- Health for the Caucasus e.V., Cottbus, Germany.,ENT Department, Carl Thiem Hospital Cottbus, Cottbus, Germany
| | - Christian Offergeld
- Health for the Caucasus e.V., Cottbus, Germany.,ENT Department, Freiburg University, Freiburg im Breisgau, Germany
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Abstract
OBJECTIVE Otologic trauma was the most common physical injury sustained after the April 15, 2013, Boston Marathon bombings. The goal of this study is to describe the resultant otologic morbidity and to report on early outcomes. STUDY DESIGN Multi-institutional prospective cohort study. METHODS Children and adults seen for otologic complaints related to the Boston Marathon bombings comprised the study population. Participants completed symptom assessments, quality-of-life questionnaires, and audiograms at initial and 6-month visits. Otologic evaluation and treatment, including tympanoplasty results, were reviewed. RESULTS More than 100 patients from eight medical campuses have been evaluated for blast-related otologic injuries; 94 have enrolled. Only 7% had any otologic symptoms before the blasts. Ninety percent of hospitalized patients sustained tympanic membrane perforation. Proximity to blast (RR = 2.7, p < 0.01) and significant nonotologic injury (RR = 2.7, p < 0.01) were positive predictors of perforation. Spontaneous healing occurred in 38% of patients, and tympanoplasty success was 86%. After oral steroid therapy in eight patients, improvement in hearing at 2 and 4 kHz was seen, although changes did not reach statistical significance. Hearing loss, tinnitus, hyperacusis, and difficulty hearing in noise remain persistent and, in some cases, progressive complaints for patients. Otologic-specific quality of life was impaired in this population. CONCLUSION Blast-related otologic injuries constitute a major source of ongoing morbidity after the Boston Marathon bombings. Continued follow-up and care of this patient population are warranted.
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Theodoroff SM, Lewis MS, Folmer RL, Henry JA, Carlson KF. Hearing Impairment and Tinnitus: Prevalence, Risk Factors, and Outcomes in US Service Members and Veterans Deployed to the Iraq and Afghanistan Wars. Epidemiol Rev 2015; 37:71-85. [DOI: 10.1093/epirev/mxu005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hong SM, Lee JH, Park CH, Kim HJ. Transverse fracture of the stapes anterior crus caused by the blast pressure from a land mine explosion. KOREAN JOURNAL OF AUDIOLOGY 2014; 18:137-40. [PMID: 25558408 PMCID: PMC4280756 DOI: 10.7874/kja.2014.18.3.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/02/2014] [Accepted: 05/15/2014] [Indexed: 11/22/2022]
Abstract
Stapes fractures without other ossicle problems are rare and ossicle problems due to explosion pressure are also rare. We describe a very rare case of stapes anterior crural fracture resulting from a land mine explosion. As this case suggests, a close examination of the ossicles is necessary during an exploration tympanotomy.
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Affiliation(s)
- Seok Min Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hallym University, Chuncheon, Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hallym University, Chuncheon, Korea
| | - Chan Hum Park
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hallym University, Chuncheon, Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hallym University, Chuncheon, Korea
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Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Coelho CB, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BCJ. A review of hyperacusis and future directions: part I. Definitions and manifestations. Am J Audiol 2014; 23:402-19. [PMID: 25104073 DOI: 10.1044/2014_aja-14-0010] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Hyperacusis can be extremely debilitating, and at present, there is no cure. We provide an overview of the field, and possible related areas, in the hope of facilitating future research. METHOD We review and reference literature on hyperacusis and related areas. We have divided the review into 2 articles. In Part I, we discuss definitions, epidemiology, different etiologies and subgroups, and how hyperacusis affects people. In Part II, we review measurements, models, mechanisms, and treatments, and we finish with some suggestions for further research. RESULTS Hyperacusis encompasses a wide range of reactions to sound, which can be grouped into the categories of excessive loudness, annoyance, fear, and pain. Many different causes have been proposed, and it will be important to appreciate and quantify different subgroups. Reasonable approaches to assessing the different forms of hyperacusis are emerging, including psychoacoustical measures, questionnaires, and brain imaging. CONCLUSIONS Hyperacusis can make life difficult for many, forcing sufferers to dramatically alter their work and social habits. We believe this is an opportune time to explore approaches to better understand and treat hyperacusis.
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Affiliation(s)
| | | | | | | | - Tom Brozoski
- Southern Illinois University School of Medicine, Springfield
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Hearing loss in the royal Norwegian Navy: a cross-sectional study. Int Arch Occup Environ Health 2014; 88:641-9. [PMID: 25287192 PMCID: PMC4435635 DOI: 10.1007/s00420-014-0988-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/22/2014] [Indexed: 12/20/2022]
Abstract
Objectives Prior studies have indicated a high prevalence of noise-induced hearing loss (NIHL) among Navy personnel; however, it is not clear whether this is caused by work on board. The present study aimed to assess the prevalence of hearing loss among Navy personnel in the Royal Norwegian Navy (RNoN), and to investigate whether there is an association between work on board RNoN vessels and occurrence of hearing loss. Methods Navy personnel currently working on board RNoN vessels were recruited to complete a questionnaire on noise exposure and health followed by pure tone audiometry. Hearing loss was defined as hearing threshold levels ≥25 dB in either ear at the frequencies 3,000, 4,000 or 6,000 Hz. Hearing thresholds were adjusted for age and gender using ISO 7029. Results The prevalence of hearing loss among Navy personnel was 31.4 %. The work exposure variables: years of work in the Navy, years on vessel(s) in the Navy and years of sailing in the Navy were associated with reduced hearing after adjusting for age, gender and otitis as an adult. Among the work exposure variables, years of sailing in the Navy was the strongest predictor of reduced hearing, and significantly reduced hearing was found at the frequencies 1,000, 3,000 and 4,000 Hz. Conclusions Our results indicate that time spent on board vessels in the RNoN is a predictor of reduced hearing.
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Knipper M, Van Dijk P, Nunes I, Rüttiger L, Zimmermann U. Advances in the neurobiology of hearing disorders: Recent developments regarding the basis of tinnitus and hyperacusis. Prog Neurobiol 2013; 111:17-33. [DOI: 10.1016/j.pneurobio.2013.08.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
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Klamkam P, Jaruchinda P, Nivatwongs S, Muninnobpamasa T, Harnchumpol P, Nirattisai S, Moungthong G. Otologic manifestations from blast injuries among military personnel in Thailand. Am J Otolaryngol 2013; 34:287-91. [PMID: 23540888 DOI: 10.1016/j.amjoto.2012.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/05/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND From November 2008 to October 2010, 565 military personnel sustained blast injury in Southernmost Thailand and 99 personnel, affected by multiple injuries, were transferred to Phramongkutklao Hospital. No data on the effect of blast injury to the ears among Thai military personnel have been reported. This study aims 1) to determine the prevalence of Sensorineural Hearing Loss (SNHL) and otologic manifestations from primary blast injury among military personnel, in Pattani, Yala and Narathiwat Provinces, and 2) to evaluate the impact of explosive devices and distance from explosion on SNHL under various conditions. MATERIALS AND METHODS A cross-sectional study was conducted among 76 military personnel injured from blast injury in Southernmost Thailand. They were divided into three groups representing the bomb blast settings; open-space referred to an area without barrier, semi-open space referred to a room open on at least one side and closed space referred to a room enclosed with four walls and ceiling. RESULTS The otologic manifestations from 76 patients were tinnitus, tympanic membrane perforation, bleeding and open wound. The prevalence of SNHL among patients in the open-, semi-open and closed space groups was 62.77%, 67.86% and 73.33%, respectively. The most common type of explosive was Improvised Explosive Devices (IEDs) 72 (94.74%). The average IED weighed 11.42kg and mean distance from explosion was 5.66m. CONCLUSION Correlation among all three incident areas and two factors: impact of explosive devices and distance from explosion are risk factors of SNHL without significance.
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The reduced cochlear output and the failure to adapt the central auditory response causes tinnitus in noise exposed rats. PLoS One 2013; 8:e57247. [PMID: 23516401 PMCID: PMC3596376 DOI: 10.1371/journal.pone.0057247] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/18/2013] [Indexed: 01/15/2023] Open
Abstract
Tinnitus is proposed to be caused by decreased central input from the cochlea, followed by increased spontaneous and evoked subcortical activity that is interpreted as compensation for increased responsiveness of central auditory circuits. We compared equally noise exposed rats separated into groups with and without tinnitus for differences in brain responsiveness relative to the degree of deafferentation in the periphery. We analyzed (1) the number of CtBP2/RIBEYE-positive particles in ribbon synapses of the inner hair cell (IHC) as a measure for deafferentation; (2) the fine structure of the amplitudes of auditory brainstem responses (ABR) reflecting differences in sound responses following decreased auditory nerve activity and (3) the expression of the activity-regulated gene Arc in the auditory cortex (AC) to identify long-lasting central activity following sensory deprivation. Following moderate trauma, 30% of animals exhibited tinnitus, similar to the tinnitus prevalence among hearing impaired humans. Although both tinnitus and no-tinnitus animals exhibited a reduced ABR wave I amplitude (generated by primary auditory nerve fibers), IHCs ribbon loss and high-frequency hearing impairment was more severe in tinnitus animals, associated with significantly reduced amplitudes of the more centrally generated wave IV and V and less intense staining of Arc mRNA and protein in the AC. The observed severe IHCs ribbon loss, the minimal restoration of ABR wave size, and reduced cortical Arc expression suggest that tinnitus is linked to a failure to adapt central circuits to reduced cochlear input.
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Noreña AJ, Farley BJ. Tinnitus-related neural activity: Theories of generation, propagation, and centralization. Hear Res 2013; 295:161-71. [DOI: 10.1016/j.heares.2012.09.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/23/2012] [Accepted: 09/26/2012] [Indexed: 01/03/2023]
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Dougherty AL, MacGregor AJ, Han PP, Viirre E, Heltemes KJ, Galarneau MR. Blast-related ear injuries among U.S. military personnel. ACTA ACUST UNITED AC 2013; 50:893-904. [DOI: 10.1682/jrrd.2012.02.0024] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 01/23/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Amber L. Dougherty
- Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA
| | - Andrew J. MacGregor
- Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA
| | - Peggy P. Han
- Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA
| | - Erik Viirre
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Kevin J. Heltemes
- Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA
| | - Michael R. Galarneau
- Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA
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Engineer ND, Rosellini WM, Tyler RS. Willingness to Accept and Pay for Implantable Tinnitus Treatments: A Survey. Neuromodulation 2012; 16:154-62. [DOI: 10.1111/j.1525-1403.2012.00487.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mao JC, Pace E, Pierozynski P, Kou Z, Shen Y, VandeVord P, Haacke EM, Zhang X, Zhang J. Blast-induced tinnitus and hearing loss in rats: behavioral and imaging assays. J Neurotrauma 2011; 29:430-44. [PMID: 21933015 DOI: 10.1089/neu.2011.1934] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract The current study used a rat model to investigate the underlying mechanisms of blast-induced tinnitus, hearing loss, and associated traumatic brain injury (TBI). Seven rats were used to evaluate behavioral evidence of tinnitus and hearing loss, and TBI using magnetic resonance imaging following a single 10-msec blast at 14 psi or 194 dB sound pressure level (SPL). The results demonstrated that the blast exposure induced early onset of tinnitus and central hearing impairment at a broad frequency range. The induced tinnitus and central hearing impairment tended to shift towards high frequencies over time. Hearing threshold measured with auditory brainstem responses also showed an immediate elevation followed by recovery on day 14, coinciding with behaviorally-measured results. Diffusion tensor magnetic resonance imaging results demonstrated significant damage and compensatory plastic changes to certain auditory brain regions, with the majority of changes occurring in the inferior colliculus and medial geniculate body. No significant microstructural changes found in the corpus callosum indicates that the currently adopted blast exposure mainly exerts effects through the auditory pathways rather than through direct impact onto the brain parenchyma. The results showed that this animal model is appropriate for investigation of the mechanisms underlying blast-induced tinnitus, hearing loss, and related TBI. Continued investigation along these lines will help identify pathology with injury/recovery patterns, aiding development of effective treatment strategies.
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Affiliation(s)
- Johnny C Mao
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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Etchelecou MC, Coulet O, Derkenne R, Tomasi M, Noreña AJ. Temporary off-frequency listening after noise trauma. Hear Res 2011; 282:81-91. [PMID: 21986211 DOI: 10.1016/j.heares.2011.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 09/20/2011] [Accepted: 09/21/2011] [Indexed: 11/25/2022]
Abstract
Hearing loss is routinely estimated from the audiogram, even though this measure gives only a rough approximation of hearing. Indeed, cochlear regions functioning poorly, if at all, called dead regions, are not detected by a simple audiogram. To detect cochlear dead regions, additional measurements of psychophysical tuning curves or thresholds in background noise (TEN test) are required. A first aim of this study was to assess the presence of dead regions after impulse noise trauma using psychophysical tuning curves. The procedure we used was based on a compromise between the need to collect reliable estimates of psychophysical tuning curves and the limited time available to obtain these estimates in a hospital setting. Psychophysical tuning curves were measured using simultaneous masking with a 2-alternative forced choice paradigm, where the target was randomly placed in one of the two masker presentations. It is well known that some components of noise-induced hearing loss are reversible. A second aim of this study was to examine the potential recovery of dead regions after acoustic trauma. A third issue addressed in this article was the relationship between noise-induced dead regions and tinnitus. We found that 70% of the subjects had dead regions after noise trauma, while 88% reported tinnitus. Moreover, we found that the extent of dead regions probably diminished in about 50% of subjects, which highlights the ability of the human auditory system to recover from noise-induced hearing loss.
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Affiliation(s)
- M-C Etchelecou
- Laveran Hospital, 34, boulevard Laveran 13013, Marseille, France
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Abstract
In recent decades, acoustic shock and explosion traumas have increased in frequency in the general population. Beside the use of fireworks and firearms, airbag ignitions and explosions caused by terror or suicidal acts are also relevant. Depending on duration and strength of the sound pressure affecting the human ear, isolated inner ear damage or additional ear drum perforation and interruption of the middle ear ossicle chain can result. By means of otoscopy, pure tone audiometry, measurement of otoacoustic emissions, and other neurootological examinations, the severity of the trauma can be determined. With prompt and adequate therapy, permanent hearing loss can be minimized. In particular, the measurement of otoacoustic emissions allows conclusions to be made on the functionality of the outer hair cells which are damaged first in most cases. Histological investigations on noise-exposed cochleas show extensive damage to the outer hair cells in the frequency range between 1.0 and 4.0 kHz, which correlates well with audiometric measurements.
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Affiliation(s)
- P S van de Weyer
- HNO-Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Deutschland.
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Noreña AJ. An integrative model of tinnitus based on a central gain controlling neural sensitivity. Neurosci Biobehav Rev 2011; 35:1089-109. [PMID: 21094182 DOI: 10.1016/j.neubiorev.2010.11.003] [Citation(s) in RCA: 285] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/20/2010] [Accepted: 11/12/2010] [Indexed: 02/03/2023]
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Abstract
The ear by design is exquisitely sensitive to barotrauma. As a result, it is typically the first organ affected in primary blast injury. The most common symptoms encountered include hearing loss, ringing, and drainage. In severe cases, the highest priority is appropriately directed toward diagnosis and treatment of life-threatening injuries; however, injury to the ear is missed frequently. With simple screening procedures, limited management, and appropriate otolaryngologic referral, acute and long-term morbidity can be averted for both critical and noncritical patients. The article provides an overview of blast mechanics and pathophysiology. It details various blast-related injuries to the external, middle, and inner ear. Standard of care assessment and management strategies are presented for acute and late otologic sequelae of the blast-injured patient.
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Affiliation(s)
- D Spencer Darley
- Department of Otolaryngologyand Communication Science, SUNY Upstate Medical University, NY, USA
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Orji F, Agu C. Patterns of hearing loss in tympanic membrane perforation resulting from physical blow to the ear: a prospective controlled cohort study. Clin Otolaryngol 2009; 34:526-32. [DOI: 10.1111/j.1749-4486.2009.02035.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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von Unge M, Dircks JJ. Functional effects of repeated pressure loads upon the tympanic membrane: mechanical stiffness measurements after simulated habitual sniffing. Eur Arch Otorhinolaryngol 2009; 266:1219-24. [PMID: 19130069 DOI: 10.1007/s00405-008-0906-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/17/2008] [Indexed: 02/07/2023]
Abstract
In experimental studies it was found that otitis media causes stiffness loss in the tympanic membrane, possible precursors to retraction pockets and cholesteatoma. Besides otitis media habitual sniffing behaviour is associated with the development of retractions. The present study aims to test the hypothesis that repeated sniffing manoeuvre may cause not only structural, epithelial tympanic membrane changes presumed to be possible precursors to retractions, but also tympanic membrane stiffness loss, another possible mediator for the development of retractions. An experimental model with a pressure chamber was used to mimic the pressure conditions for the tympanic membrane in habitual sniffers' ears. The stiffness properties of twelve Mongolian gerbil tympanic membranes were measured with moiré interferometry after varying time up to 12 days with repeated pressure loading. Three days later, lower overall displacement were obtained in two ears; after 7-12 days the displacement readings were normal. This study with maximum of 12 days of pressure loading did not verify the hypothesis that habitual "sniffing" impairs the stiffness of the tympanic membrane.
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Affiliation(s)
- Magnus von Unge
- Department of ENT, Karolinska Hospital and Institute, Stockholm, Sweden.
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Nageris BI, Attias J, Shemesh R. Otologic and audiologic lesions due to blast injury. J Basic Clin Physiol Pharmacol 2008; 19:185-91. [PMID: 19025030 DOI: 10.1515/jbcpp.2008.19.3-4.185] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the effect of blast injury on the otologic and hearing state over time. SETTING Otology unit of a tertiary referral center. METHODS Seventy-three patients aged 16 to 73 years who sustained physical trauma from an explosion underwent otologic and audiologic examination 3-4 months and one year later. RESULTS At the first examination, high-frequency sensorineural hearing loss was detected in 57 patients (78%), mixed hearing loss in 13 (19%), and low-tone conductive hearing loss in two (3%). Conductive hearing loss had improved by one year, while the cochlear hearing loss, in most cases, did not. Only 7% of the patients with tinnitus reported improvement after one year. CONCLUSIONS The permanent otologic damage caused by blast injury cannot be determined before one year after the traumatic event.
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Affiliation(s)
- Ben I Nageris
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tiqwa, Israel.
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Tympanic membrane perforation and hearing loss from blast overpressure in Operation Enduring Freedom and Operation Iraqi Freedom wounded. ACTA ACUST UNITED AC 2008; 64:S174-8; discussion S178. [PMID: 18376162 DOI: 10.1097/ta.0b013e318160773e] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tympanic membrane perforation is the most common primary blast injury in the current conflicts and occurs in approximately one tenth of service members wounded by combat explosions. We wanted to determine the severity of perforation and its effect on hearing and combat readiness. METHODS This analysis is a retrospective study of US service members injured in combat explosions in Afghanistan or Iraq and treated at our institution between March 2003 and July 2006. Data captured included location and grade of perforation, symptoms, healing rates, audiogram results, need for hearing aids, and loss of eligibility for military service. RESULTS Of 436 explosion-wounded patients admitted to our facility, 65 (15%) patients had tympanic membrane perforation diagnosed by the otolaryngology service. A total of 97 tympanic membrane perforations occurred among 65 patients. The average surface area involved was 41% +/- 32% (right) and 35% +/- 34% (left). More than one third of perforations were grade 4. The most common locations were central and anterior-inferior. Most (83%) patients reported symptoms, most commonly diminished hearing (77%) and tinnitus (50%). Outcome data were available for 77% of perforations. Spontaneous healing occurred in 48%. The remainder (52%) had surgical intervention. The most common audiogram abnormality was mild high frequency hearing loss. Ultimately, three patients (5%) required hearing aids and one discharge from military service. CONCLUSIONS Tympanic membrane perforation occurs in 16% of explosion-injured patients. Most patients are symptomatic and many have large perforations requiring operative intervention. Long-term hearing loss is uncommon but does impact ability to continue military service.
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Rivière S, Schwoebel V, Lapierre-Duval K, Warret G, Saturnin M, Avan P, Job A, Lang T. Hearing status after an industrial explosion: experience of the AZF explosion, 21 September 2001, France. Int Arch Occup Environ Health 2007; 81:409-14. [PMID: 17671790 DOI: 10.1007/s00420-007-0227-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 06/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Following the explosion of a chemical plant in France, a study was conducted to analyse the relationship between hearing thresholds and distance from the explosion based on post- and pre-blast audiometric data, and to describe the functional symptoms and visits for hearing problems. METHODS Audiometric tests with standard procedure of 511 workers of a company located near the explosion were proposed and conducted by the occupational medicine department after the explosion. Past occupational noise exposure, past medical history of ear problems, distance from the explosion, functional symptoms and visits for hearing problems following explosion and results of past audiometric tests if available were collected. Workers were classified as "exposed" or "less exposed" according to the distance from the explosion. Mean decibel threshold shifts for each ear were analysed by frequency with Student's t test and by multiple linear regression taking into account confounding factors. RESULTS Of a total of 425 (83%) of the firm's workers who participated in the study, 49% had received an audiometric test before the explosion. Hearing shift between pre- and post-explosion audiograms was significantly greater for the "exposed" group than for the "less exposed" one at 2,000 and 4,000 Hz (P < 0.05, P < 0.001, respectively) and borderline at 6,000 Hz (P = 0.09) for the right ear and at 2,000 (P < 0.01), 6,000 and 8,000 Hz (P < 0.05) for the left ear. Among those of the "exposed" workers who reported any functional symptom following the explosion, 45% did not visit an ENT specialist despite these signs. CONCLUSIONS The study demonstrated statistically significant hearing shift from 2,000 to 6,000 Hz in relation with distance from the explosion and showed that even when functional symptoms were present, people did not necessarily seek medical advice. Screening for hearing loss should be recommended for people most exposed to excess acoustic pressure, in order to offer them prevention advice.
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Affiliation(s)
- Stéphanie Rivière
- Institut de Veille Sanitaire (InVS), CIRE, DRASS Midi-Pyrénées, 10 chemin du raisin, 31050,Toulouse cedex, France.
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