1
|
Teitelbaum T, Shochat I, Grinblat G, Taha M, Braverman I. Hemotympanum as a Complication of a Valsalva Maneuver during Childbirth. Case Rep Otolaryngol 2023; 2023:3328895. [PMID: 37593658 PMCID: PMC10432077 DOI: 10.1155/2023/3328895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/29/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
Background Hemotympanum may occur due to otic barotrauma secondary to Valsalva maneuver during the second phase of labor. A pressure differential across the tympanic membrane (TM) of about five psi can cause rupture. The increased intrathoracic and intraabdominal pressure spikes repeatedly manifested by "pushing" during second-stage labor easily approach (and may exceed) this level. Clinical Presentation. This case report describes a healthy thirty-seven-year-old multipara patient admitted for the 40-weeks' gestational age routine follow-up that proceeded to active labor followed by an aural fullness and bloody otorrhea. Otoscopic examination with a light microscope confirmed the hemotympanum of the right tympanic membrane. Conclusion Forceful Valsalva can cause hemotympanum. Investigating the benefits and disadvantages of the pushing methods could help reduce such complications in the future. A prompt evaluation of an otolaryngologist should be requested in the event of a new postpartum hearing disturbance or bloody otorrhea.
Collapse
Affiliation(s)
- Tali Teitelbaum
- Hillel Yaffe Medical Centre, Technion Faculty of Medicine, Hadera, Israel
| | - Isaac Shochat
- Hillel Yaffe Medical Centre, Technion Faculty of Medicine, Hadera, Israel
| | - Golda Grinblat
- Hillel Yaffe Medical Centre, Technion Faculty of Medicine, Hadera, Israel
| | - Mohamad Taha
- Hillel Yaffe Medical Centre, Technion Faculty of Medicine, Hadera, Israel
| | - Itzhak Braverman
- Hillel Yaffe Medical Centre, Technion Faculty of Medicine, Hadera, Israel
| |
Collapse
|
2
|
McEvoy CB, Crabtree A, Powell JR, Meabon JS, Mihalik JP. Cumulative Blast Exposure Estimate Model for Special Operations Forces Combat Soldiers. J Neurotrauma 2023; 40:318-325. [PMID: 35934872 DOI: 10.1089/neu.2022.0075] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Special Operations Forces (SOF) Service members endure frequent exposures to blast and overpressure mechanisms given their high training tempo. The link between cumulative subconcussive blasts on short- and long-term neurological impairment is largely understudied. Neurodegenerative diseases such as brain dysfunction, cognitive decline, mild cognitive impairment, and dementia may develop with chronic exposures. This hypothesis remains unproven because of lack of ecologically valid occupational blast exposure surveillance among SOF Service members. The purpose of the study was to measure occupational blast exposures in a close quarter battle (CQB) training environment and to use those outcomes to develop a pragmatic cumulative blast exposure (CBE) estimate model. Four blast silhouettes equipped with a field-deployable wireless blast gauge system were positioned in breaching positions during CQB training scenarios. Silhouettes were exposed to flashbangs and three interior breaching charges (single strand roll-up interior charge, 300 grain (gr) explosive cutting tape (ECT), and Jelly charge). Mean blast measures were calculated for each silhouette for flashbangs (n = 93), single strand roll-up interior charge (n = 80), 300 gr ECT (n = 28), and Jelly charge (n = 71). Mean peak blast pressures per detonation are reported as follows: (1) flashbangs (1.97 pounds per square inch [psi]); (2) single strand roll-up interior charge (3.88 psi); (3) 300 gr ECT (2.78 psi); and (4) Jelly charge (1.89 psi). Pragmatic CBE estimates for SOF Service members suggest 36.8 psi, 184 psi, and 2760 psi may represent daily, weekly, and training cycle cumulative pressure exposures. Estimating blast exposures during routine CQB training can be determined from empirical measures taken in CQB environments. Factoring in daily, weekly, training cycle, or even career length may reasonably estimate cumulative occupational training blast exposures for SOF Service members. Future work may permit more granular exposure estimates based on operational blast exposures and those experienced by other military occupational specialties.
Collapse
Affiliation(s)
- Cory B McEvoy
- United States Army Special Operations Command, Fort Bragg, North Carolina, USA.,CU Anschutz Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam Crabtree
- United States Army Special Operations Command, Fort Bragg, North Carolina, USA
| | - Jacob R Powell
- Matthew Gfeller Center, Department of Exercise and Sport Science, Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Human Movement Science Curriculum, Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James S Meabon
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jason P Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Human Movement Science Curriculum, Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
3
|
Barranco R, Tettamanti C, Bonsignore A, Ventura F. Otorrhagia in strangulations: An important but often underestimated finding in forensic pathology. J Forensic Sci 2022; 67:1739-1742. [DOI: 10.1111/1556-4029.15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rosario Barranco
- Department of Legal and Forensic Medicine University of Genova Genoa Italy
| | - Camilla Tettamanti
- Department of Legal and Forensic Medicine University of Genova Genoa Italy
| | | | - Francesco Ventura
- Department of Legal and Forensic Medicine University of Genova Genoa Italy
| |
Collapse
|
4
|
Petechial hemorrhages of the tympanic membrane in attempted suicide by hanging: A case report. J Forensic Leg Med 2012; 20:119-21. [PMID: 23357399 DOI: 10.1016/j.jflm.2012.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 04/23/2012] [Accepted: 05/29/2012] [Indexed: 11/20/2022]
Abstract
It is important to determine whether a person has been strangulated and the diagnosis is not always straightforward since ligature marks are not always present. In forensic medicine the physical examination recommended is careful inspection of the head and neck region, oral cavity, examination of the eyes including the conjunctiva on both the upper and lower eyelids and photo documentation. Petechial hemorrhages of the conjunctiva are considered marker of life threatening hanging or strangulation. Hemorrhage from ears, perforated tympanic membrane and haematotympanum are scarcely described in case reports of strangulated patients. To our knowledge we are the first to report petechial hemorrhages of the tympanic membrane in a patient following attempted suicide by hanging. We believe that the petechial hemorrhages develop from the capillaries located in lamina propria of the epidermal layer above the fibrous layer. This assumption is made on the basis of our assessment of a normal tympanic membrane with light microscopy. Petechial hemorrhages of the tympanic membrane might in fact be the only sign of life threatening pressure applied to the neck. This is a very important finding and prospective studies should be conducted for further clarification on the matter.
Collapse
|