Lightning and its effects on the auditory system

ASIAN ELEPHANT (ELEPHAS MAXIMUS) SUFFERING FROM LIGHTNING STRIKE SUCCESSFULLY TREATED BY INTEGRATIVE VETERINARY MEDICINE

A captive female Asian elephant (Elephas maximus), approximately 30 yr old, was struck by lightning and displayed obtundation, dysphagia, drooling, and muscle weakness. A physical examination, hematologic test, blood gas analysis, and electrocardiogram were performed. Treatments included the administration of mannitol, dexamethasone, antibiotics, analgesics, vitamins, and intravenous fluid. Conventional therapy resulted in improvement but not complete resolution of clinical signs. Therefore, acupuncture was integrated into the treatment protocol. Electroacupuncture and laser acupuncture were administered every other day; aqua acupuncture was administered once a week. No complications were observed during acupuncture treatment. Acupuncture, a form of traditional Chinese veterinary medicine (TCVM), contributed to the resolution of clinical signs in this case and may be an effective adjunctive treatment for other neurologic disorders in elephants.

Lightning and the Forensic Pathologist

This paper explores the pathology caused by lightning. It covers the basic physics and mechanisms of injury of lightning strikes followed by a short discussion. The purpose of this paper is to suggest an approach to the investigation and autopsy of a lightning-related death.

Neurotological findings after electrical injury at the workplace

OBJECTIVES/HYPOTHESIS

Neurotological findings secondary to electrical injuries have rarely been reported in the world literature. We attempt to characterize the neurotological findings following electrical injury and to determine the role head injury and loss of consciousness play in this population's clinical presentation.

STUDY DESIGN

Retrospective cohort study.

METHODS

A database containing 3,438 patients with work-related injuries was scanned for individuals who sustained and survived electrical injuries at work. Detailed analysis of the frequencies of presenting features and test results was performed. A comparative analysis was made between the subsets of patients with and without loss of consciousness and/or head injury.

RESULTS

A cohort of 42 patients was identified. All patients had multiple symptoms. Dizziness was a significant complaint in all workers with electrical injuries. Other common complaints included tinnitus and imbalance. Characterization of these symptoms is provided in detail according to statistical frequency. In this cohort, 25 workers had a concomitant head injury and 17 workers had an associated loss of consciousness. There was no statistically significant difference when clinical presentation, examination, and balance testing results were compared between the subsets.

CONCLUSIONS

Frequency and characterization of symptoms following electrical injury are provided. Dizziness is the most common presenting neurotological feature. Loss of consciousness and/or associated head injury do not affect the clinical presentation in this particular population.

LEVEL OF EVIDENCE

2b. Laryngoscope, 127:2126-2131, 2017.

Tympanic Membrane Perforation Caused by Thunderbolt Strike

Thunderbolt strike is a life-threatening entity. In the patients presenting with thunderbolt strike, the central nervous system and the cardiovascular system should be primarily evaluated, followed by tympanic membrane lesions. The most important symptom connected with ear is the loss of hearing. In this report, a 43-year-old male patient with unilateral tympanic membrane perforation, tinnitus, and bilateral sensorineural hearing loss caused by thunderbolt strike is presented through a review of the literature.

The Explosive Effects of Lightning: What are the Risks?

The explosive effects of lightning have been known to exist for some time; however the precise risks associated with it have been generally unknown. This curious injury phenomenon has existed historically under many different names in the literature: "lightning's pressure blast wave," "arc blast," "shattering effects of lightning," "pressures developed by arcs," "thunder generation of shock waves," and "the sixth mechanism of lightning injury" are but a few of the many divergent and disparate terminologies used in the past to describe this invisible blast phenomenon. Blunt force trauma injuries and barotrauma injuries are often identified on lightning strike victims. Lightning's pressure blast wave and its associated overpressure does appear to have significant injury implications associated with it. This paper takes an in-depth look at the explosive effects of lightning and the main blast-related pathologies seen on lightning strike victims. Knowledge and insight into this phenomenon may help forensic pathologists and those working in the fields of lightning injury and lightning protection. A general literature search of the medical, the electrical engineering, and the mechanical engineering literature was conducted. By looking exclusively at the pathology of barotrauma in the human body, forensic pathologists may now get a relatively good idea as to the possible overpressures and distances involved with regards to lightning's explosive effects.

Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269.

Isolated Sensorineural Hearing Loss as a Sequela after Lightning Strike

In most of the surviving patients after a lightning strike, audiovestibular abnormalities have been reported. The most frequently reported type of abnormalities is a tympanic membrane perforation with hearing loss and external ear canal burn. However a sensor neural hearing loss and mixed type hearing loss can also occur, but these occur rarely. A nineteen-year-old female patient had, after a lightning strike, serious burns on the left ear, behind the ear, and on the chest and neck. She also had in her left ear 108 dB hearing loss with irregular central perforation and in her right ear 52 dB sensorineural hearing loss. There was no hearing loss before the strike. A hearing aid was recommended for the right ear and good care and follow-up were recommended for the left ear. A lightning strike can cause serious audiological damage. Therefore, it is necessary to make a careful audiovestibular evaluation of the patients. Although there exist rarely healed cases from sensorineural hearing loss after lightning strike in literature, in our case hearing loss occurred bilaterally and then it healed unilaterally. This condition is quite rare in literature.

Lightning injury: a review

Lightning is an uncommon but potentially devastating cause of injury in patients presenting to burn centers. These injuries feature unusual symptoms, high mortality, and significant long-term morbidity. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries.

Vestibular signs associated with suspected lightning strike in two horses

Two previously healthy 14-year-old horses developed right-sided unilateral vestibular signs after they had possibly been struck by lightning. Repeated radiographic and endoscopic evaluations did not reveal any significant changes. A brainstem auditory evoked response test indicated a subtle left to right interaural latency difference of waves I, III and V in the more severely affected pony, but its central conduction time remained normal.

Overlay versus underlay tympanoplasty. Part I: historical review of the literature

The history of otology is the history of the successful treatment of infections of the middle ear and the eardrum. Otologists have sought to restore hearing lost to infections of the eardrum since the 1600s. The development of instruments, techniques, and materials to treat infection is fascinating because of the serendipitous nature of the discoveries and the insight of the discoverers. This historical review describes the history of the treatment of infections of the ear and the development of modern techniques of ear surgery. Two contemporary methods of tympanic membrane repair are then described.

An unusual case of lightning strike: full-thickness burns of the cranial bones

An unusual full-thickness burn of the scalp and cranial bones due to a lightning strike is reported. A thick nylon cover protected the head from the direct effects of the lightning injury, but heated water over the thick nylon cover caused full-thickness burn of the scalp and cranial bones. The relevant literature has been reviewed.

Acoustic trauma caused by lightning

Lesions produced by exposure to noise are frequent in everyday life. Injuries may be found in all systems of the human body, from the digestive to the endocrine, from the cardiovascular to the nervous system. Many organs may be damaged, the ear being one of them. It is known that noise produced by factories, airports, musical instruments and even toys can cause auditory loss. Noises in nature can also cause acoustic trauma. This report is the case history of acoustic trauma caused by lightning. The patient was studied with CAT scan, electroencephalogram, and brain mapping, impedance audiometry with tympanogram and acoustic reflex, audiometry and evoked otoacoustics emissions: distortion products and transients.

Hearing loss in the 4-8 kHz range following tympanic membrane perforation from minor trauma

This study looked at the incidence of sensorineural hearing loss in the 4-8 kHz range in patients with unilateral tympanic membrane perforations from minor trauma who presented to the department in the past year. Eleven patients conformed to our inclusion criteria, one was lost to follow-up. Perforation was present in all patients in the pars tensa and no treatment was required in nine patients. The mean sensorineural hearing loss at 4,6 and 8 kHz was 28.2 dB on initial examination and 14.6 dB by Day 30. All 11 patients had normal hearing in the contra-lateral ear (mean 13.5 dB). In this group of patients with a tympanic membrane perforation from minor trauma the conductive hearing loss was accompanied by a significant (P = 0.001) but reversible high frequency sensorineural deafness.

Lightning injury of the tympanic membrane

A number of cases of otologic injuries by lighting strikes have been described in the otolaryngological literature. The mechanism of these injuries remains uncertain. We report 3 cases of lightning injury that presented to us. Analysis of these cases suggests that the mechanism of injury is direct conduction of electricity from the scalp to the soft tissues of the external auditory canal to the tympanic membrane. The conduits of the electrical surge are the subcutaneous blood vessels, smaller vessels being damaged more than larger vessels. Since the tympanic membrane central vessels are smaller than the canal vessels, the central area of the tympanic membrane would be most vulnerable, and this is seen clinically. A review of the literature supports this proposed mechanism of injury.

Electrical shock and lightning strike

Cardiac arrest from electrical shock or lightning strike is associated with significant mortality and requires modification and extension of standard advanced life support measures to achieve successful resuscitation. Patients who experience electrical shock or lightning strike may sustain cardiac and respiratory arrest secondary to the direct effects of current. However, the majority of victims have associated multisystem involvement, including neurologic complications, cutaneous burns, and associated blunt trauma. As a result, a combination of advanced cardiac life support measures and advanced trauma life support techniques is indicated. Victims with cardiac arrest from electrical shock or lightning strike require prompt, aggressive resuscitation using standard methods for airway control, ventilation, and chest compressions, as well as usual measures for defibrillation and cardiac pharmacotherapy. Unique considerations include vigorous fluid resuscitation and spinal immobilization for victims of electrical shock and reversal of normal multiple casualty triage priorities when managing several lightning strike victims. Because the majority of victims are relatively young and seldom have significant underlying cardiac disease, the chance for successful resuscitation may be greater for patients who experience sudden death from electrical shock or lightning strike than for those with other causes of cardiac arrest, even among patients with initial rhythms traditionally unresponsive to therapy. Although numerous specialized aspects are required for the successful management of victims of electrical shock and lightning strike, the following article focuses on the unique considerations necessary for immediate care of cardiac arrest victims, with emphasis on the underlying mechanisms of sudden death and currently recommended guidelines for resuscitation.