Long-Term Hearing Loss after Acute Acoustic Trauma in the French Military: A Retrospective Study

INTRODUCTION

Acute acoustic trauma (AAT) is characterized by cochlea-vestibular signs following intense noise exposure, often caused by impulse noise. French military faces a high risk of AAT because of the use of weapons with peak sound levels exceeding 150 dB. Hearing loss (HL) resulting from AAT can have a significant impact on quality of life and operational capacity. The aim of this study was to assess the prevalence of long-term hearing impairment after AAT.

MATERIALS AND METHODS

The study involved a retrospective review of computer-based patient records from four military medical centers in Northeast France between January 2016 and December 2021. The inclusion criteria required the presence of cochlea-vestibular signs following impulse acoustic exposure and the absence of other causes. Sociodemographic and clinical data were collected, including audiometric data before and after exposure. The primary end point was the presence of a threshold elevation greater than 10 dB between reference and late audiograms.

RESULTS

A total of 419 patients were included in the analysis, with a majority of males (n = 419; 84.7%) and a mean age of 23.6 yrs. The most common causative agent was the 5.56-mm assault rifle (n = 327; 78.0%). Tinnitus was the most frequent symptom (n = 366; 87.4%), followed by hypoacusis (n = 147; 35.1%) and earache (n = 89; 21.2%). The initial audiograms showed no HL in 31.0% of cases, while the mean deficit across all frequencies was 15.4 dB. All patients received corticosteroid therapy, with a mean duration of 6.0 d. Late audiograms conducted at an average interval of 448.0 d after AAT revealed a prevalence of long-term HL exceeding 20%. Higher doses of corticosteroid therapy (>1 mg/kg) were associated with a reduced frequency of long-term HL.

CONCLUSIONS

This study highlights the prevalence of long-term hearing impairment after AAT in the French military. The findings emphasize the importance of preventive measures, including proper use of hearing protection devices, and the need for timely diagnosis and treatment. Further research is warranted to explore gender susceptibility to AAT and evaluate the impact of different weapons on AAT characteristics. The study also underscores the potential benefits of higher doses of corticosteroid therapy in reducing the risk of long-term hearing impairment. Overall, the findings contribute to a better understanding of AAT and can inform strategies for its prevention and management in military settings.

Surgical tracheotomy

In spite of the ever-increasing hyper-specialization of gastro-intestinal surgeons, some surgical emergency procedures, such as tracheotomy, need to be mastered. The need for tracheotomy is sometimes so urgent that one cannot wait for a specialized surgeon to arrive or to transport the patient elsewhere. Even though percutaneous tracheotomy, as performed by intensive care physicians, represents an alternative to surgical tracheotomy, it is not always possible.

Presbycusis and Fitness to Fly

BACKGROUND: When a pilot is referred for presbycusis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of presbycusis in a pilot population and to discuss the decisions about their flight waivers.METHODS: There were 19 pilots who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined.RESULTS: Of the 19 patients, 5 did not obtain flight fitness waivers. Among the 14 who received waivers, 7 had no restrictions on their flight fitness.DISCUSSION: Flight fitness was based on the maximum percentage of speech recognition and the slope of the curve for speech recognition in speech audiometry in noise and the follow-up of these findings. The results made it possible to determine a patient's fitness to fly with a waiver, which may be associated with restrictions. In our series, only 5 pilots out of 19 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who had presbycusis and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant cochlear assessment, presbycusis may allow for a safe pursuit of aviation activity.Ballivet de Régloix S, Genestier L, Maurin O, Marty S, Crambert A, Pons Y. Presbycusis and fitness to fly. Aerosp Med Hum Perform. 2020; 91(5):403-408.

Deployment of the Surgical Life-saving Module (SLM) in 2017: Lessons learned in setting up and training operational surgical units

INTRODUCTION

The military operations carried out by the French armed forces, occasionally require the use of the Surgical Life-saving Module (SLM), to ensure the surgical support of its soldiers. Due to its extreme mobility and capacity of fast deployment, SLM is particularly useful in small-scale military operations, such as Special Forces missions. In 2017, the French SLM was for the first time used to ensure surgical support of allied forces, which were lacking forward surgical capabilities.

MATERIALS AND METHODS

the SLM is a mobile, heliborne, airborne, surgical structure with parachuting capability onto land or sea, therefore essentially focused on life-saving procedures, also known as "damage control" surgery. Due to the need for mobility and rapid implementation, the SLM is limited to a maximum of 5 interventions or, in terms of injuries, to 1 or 2 seriously injured patients.

RESULTS

Over a period of 2 months, 5 medical teams were successively deployed with the SLM. A total of 157 casualties were treated. The most common injuries were caused by shrapnel 561%), followed by firearms (36%), and blunt trauma (2.5%). Injuries included the limbs (56%), thorax (18%), abdomen (13%), head (11%), and neck (2%). The average ISS was 8.5 (1-25) with 26 patients presenting with an ISS greater than or equal to 15. The average NISS was 10.8 (1-75) with 34 casualties having an NISS equal to or greater than 15. The surgical procedures were broken down as follows: 126 dressings, 16 laparotomies, 7 thoracotomies, 12 isolated thoracic drains (without thoracotomy), 1 cervicotomy, 12 amputations, 7 limb splints, 2 limb fasciotomies, 2 external fixators and 1 femoral fracture traction.

CONCLUSIONS

The numerous SLM deployments in larger operations highlighted its ability to adapt both in terms of equipment and personnel. Continuous management of equipment logistics, robust personnel training, and appropriate organization of the evacuation procedures, were the key elements for optimizing combat casualty care. As a consequence, the SLM appears to be an operational surgical unit of choice during deployments.

[Congenital cysts and fistulas on the neck in adults]

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. This must be a diagnosis made by elimination; a cervical tumor must evoke the diagnosis of cancer. A cutaneous fistula or a cervical tumor, chronic or recent appearance in an inflammatory context, are the clinical signs. The thyroglossal duct cysts and the second branchial clefts cysts are the most common causes of median and lateral cervical cysts, respectively. Imaging contributes greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is initially based on antibiotic therapy and then on complete surgical excision, away from an infectious episode, the sole guarantee for the absence of local recurrence.

Comparison of Penetrating Neck Injury Management in Combat Versus Civilian Trauma: A Review of 55 Cases

The objective was to describe a case series of penetrating neck injuries (PNIs) and compare their management in combat versus civilian trauma.

METHODS

From 2012 to 2014, all soldiers and civilians referred to Percy Military Training Hospital for PNI were analyzed. The mechanism of injury, type and site of the lesion, and initial emergency management were noted.

RESULTS

Among the 55 patients, 26 were wounded in action, and 29 were civilians. PNIs were commonly stab wounds resulting from an assault. Anatomical zone II, as well as the central neck compartment, was the most affected area. The most affected organ was the larynx. 74% of patients underwent computed tomography angiography (CTA), surgical exploration was performed for 42% of patients, and 33% of patients required intensive care unit monitoring. The differences between the two groups in terms of management were not statistically significant.

CONCLUSIONS

The current management is based on clinical examination and CTA and is similar between soldiers and civilians. Surgical exploration is less commonly used than CTA, which is a fast and accurate method to evaluate PNI for stable patients. The classification by compartment seems more relevant than the classification by anatomical zone, particularly in absence of medical imaging.

[Complications of sinusitis]

The complications of sinusitis are essentially secondary to ethmoidal and frontal sinusitis, occurring in patients weakened, particularly in case of immunodeficiency or anatomical defects. The gravity is due to the risk of spreading infection in intracranial tissues and orbital cavity. The diagnosis is always to discuss any symptomatology resistant to treatment and the appearance of orbital or neurological signs. The scanner and MRI contribute greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is based on prolonged antibiotic therapy and surgery and requires a multidisciplinary approach involving ENT, ophthalmologist, neurosurgeon and anesthesiologist resuscitator.

Fishbones in the Upper Aerodigestive Tract: A Review of 24 Cases of Adult Patients

INTRODUCTION

We present a retrospective study series and discussion of the current literature to discuss the management of fishbones in the upper aerodigestive tract.

MATERIALS AND METHODS

From January 2013 to July 2016, all patients referred to our referral center because of a fishbone in the upper aerodigestive tract were analysed.

RESULTS

Of the 24 patients, 95% of them reported discomfort in the throat. It was noted that 58% of physical examinations and nasofibroscopy results were normal. Ten fishbones were found in the upper aerodigestive tract. They were removed by foreign body forceps or by endoscopy depending on the location. Foreign body-related complications were not observed. Ten patients with no identifiable fishbone had no symptoms after 48 hours. Other patients, including the 10 patients with the fishbone removed, were asymptomatic after 10 days.

CONCLUSION

From our experience, we recommend a systematic nasofibroscopy. If it is normal, the patient is assessed at 48h. The complementary investigation by CT scan and/or oesophagoscopy must be reserved in cases of suspicion of oesophageal localization or complication. Otherwise, rigid or flexible endoscopy may be performed when laryngoscopy is unsuccessful or for the treatment of foreign bodies lodged below this area.

Endoscopic septoplasty: Learning curve

AIMS

The aim of the current study was to report the learning curve for endoscopic septoplasty for a senior surgeon already trained in endonasal sinus surgery.

MATERIAL AND METHODS

From November 2011 to September 2012, 100 patients were prospectively included and grouped in 5 consecutive groups of 20 by date of surgery. The primary endpoint was operative time. Intra- and postoperative complications and functional assessment were also analyzed.

RESULTS

Operative time decreased with the surgeon's experience and became stable after 60 procedures. Operative time saving was about 10min per 20 procedures. Mean operative time was stable between groups 4 (21.1±9.6min) and 5 (19.2±8.2min). There was a 2% rate of conversion to conventional surgery for technical problems. The number of procedures free of accidental mucosal lesion increased and became stable after 40 procedures. There was a 4% rate of residual postoperative perforation. Nasal Obstruction and Septoplasty Effectiveness (NOSE) score improved postoperatively in each group (P<0.05).

CONCLUSION

After 60 endoscopic septoplasty procedures, a senior surgeon masters the surgical technique with satisfactory operative times, and a decreasing rate of intra- and postoperative complications.

Endoscopic vs. conventional septoplasty: A review of the literature

The aim of this review of literature was to compare conventional and endoscopic septoplasty in terms of operating time, functional efficacy and perioperative morbidity. A systematic review of the scientific literature was performed on the PubMed database, Google and Google Scholar, searching for randomized prospective trials comparing endoscopic and conventional septoplasty. The primary endpoint was operating time, and the secondary endpoints were intra- and postoperative complications, postoperative pain, hospital stay and functional result. Twenty-nine articles published between 1991 and 2012 compared conventional and endoscopic septoplasty, five of which were prospective randomized trials. Operating time was shorter with endoscopic surgery (P<0.001), with less mucosal damage (P<0.01); there was less synechia (P<0.01) and residual deformity (P<0.05); and postoperative pain was milder. Endoscopic septoplasty thus shortened surgery time and reduced perioperative complications, but the functional result was the same as with conventional septoplasty.

[Facial nerve monitoring in the parotidectomy]

INTRODUCTION

Facial palsy (FP) is a feared complication of parotidectomy. Facial nerve monitoring (FNM) has been poorly evaluated since it was created at the beginning of the 90's. The authors described a retrospective series and discussed it reviewing the literature data.

SUBJECTS AND METHOD

From January 2002 to January 2009, 75 parotidectomies were performed in 72 patients (34 males, 38 females), without FNM in 28 cases (group 1) and with FNM in 47 cases (group 2).

RESULTS

In group 1, 9 FP were noted, 5 were transient and 4 were definitive. In group 2, 12 FP were noted, 9 were transient and 3 were definitive. Both one month and six months after parotidectomy, the FP rate was significatively higher in group 1 than in group 2 for the reoperations.

CONCLUSIONS

Facial nerve monitoring is an adjunctive method available to a surgeon during parotid surgery to assist with the functional preservation of the facial nerve. It did not allow to improve the facial prognosis in benign tumours removal but it improved the facial prognosis in reoperations. Its interest should be tested for malignant tumour removal.