An analysis of our series of seven patients who have survived lightning strokes and a review of such cases mentioned in the world literature since 1960 reveals that the most common audiovestibular lesion in lightning survivors is tympanic membrane rupture. Of the various injury‐producing properties of lightning, the one most likely implicated in the pathogenesis of these lesions is the cylindrical shock wave which expands from the axis of the lighting bolt. The tympanic membrane in close proximity to the lightning bolt is suddenly stressed with enough force to cause its rupture.
Lightning victims may also manifest various forms of neurosensory deafness and dizziness of central or vestibular origin. Possible explanations for these lesions are described but are primarily conjectural.
Otologic management of these cases varies with the lesion sustained. Cochlear, retrocochlear and vestibular lesions are usually treated expectantly and medically as symptoms indicate. Surgical treatment is reserved for incapacitating vestibular problems unresponsive to conservative treatment and to reconstructive approaches to the tympanic membrane and middle ear when indicated.
In this review of 925 cases of total and anterior perforations of the tympanic membrane reconstructed through the use of formaldehyde-formed-fascia (3-F) grafts, the postoperative nonperforation rate is 97.6%; blunting and/or lateralization of the graft was avoided in 93.5% of cases. Closure of the postoperative air-bone gap within 20 dB was achieved in 70% of cases. This update of a previously reported paper reinforces our opinion that the 3-F graft is an effective tool for the closure of tympanic membrane perforation with or without ossicular chain reconstruction.
Elevations in the concentration of plasma angiotensin II (All) and decline in plasma aldosterone (Aid) were noted in African Green monkeys at 48 hr of water deprivation but not subsequent to an equivalent duration of food deprivation, compared with nondeprived levels. In a second experiment, drinking was initiated following treatment with All, hypertonic saline, and the /3-adrenergic stimulator isoproterenol. Concomitant elevations in plasma All concentrations were measured following isoproterenol injection, but not after All or hypertonic saline injection, when compared with isotonic saline treatment. Elevations in plasma Aid levels were noted following All injection. A third experiment evaluated dipsogenic additivity of stimuli by comparing the volumes of water consumed following isoproterenol or hypertonic saline injection with the intake resulting from combined treatment with isoproterenol and hypertonic saline. Additivity was tested under ad lib conditions and following adaptation to a daily water deprivation regimen. The results of the first two experiments generally agree with predictions based on the respective contributions by intracellular dehydration and extracellular fluid volume depletion, to thirst. However, additivity of thirst stimuli was not demonstrated in the third experiment.Angiotensin II (All) has been shown to play an important role in the drinking behavior of a number of species. Intravenous infusion or intraperitoneal injection of All stimulates drinking in the rat (Fitzsimons &
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