Otologic Considerations of Blast Injury

Darley, D. Spencer; Kellman, Robert M.

doi:10.1001/dmphp.d-08-00057r2

Cited by 26 publications

(21 citation statements)

References 36 publications

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“…(1) As previously stated, diagnosis of pulmonary barotrauma from salvaged bat lungs is not possible due to confounding artifacts and competing diagnoses. Ancillary techniques, such as assessment for ruptured tympana, a tissue sensitive to barotrauma, 11,18,26 may be a useful alternative to lungs in salvaged bat carcasses. (2) Histologic markers (eg, peripheral pallor in lungs; Fig.…”

Section: Discussionmentioning

confidence: 99%

A Forensic Investigation Into the Etiology of Bat Mortality at a Wind Farm: Barotrauma or Traumatic Injury?

et al. 2012

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Migrating bats have increased mortality near moving turbine blades at wind farms. The authors evaluated competing hypotheses of barotrauma and traumatic injury to determine the cause. They first examined the utility of lungs from salvaged bat carcasses for histopathologic diagnosis of barotrauma and studied laboratory mice as a model system. Postmortem time, environmental temperature, and freezing of carcasses all affected the development of vascular congestion, hemorrhage, and edema. These common tissue artifacts mimicked the diagnostic criteria of pulmonary barotrauma; therefore, lung tissues from salvaged bats should not be used for barotrauma diagnosis. The authors next compared wind farm (WF) bats to building collision (BC) bats collected near downtown Chicago buildings. WF bats had an increased incidence in fracture cases and specific bone fractures and had more external lacerations than BC bats. WF bats had additional features of traumatic injury, including diaphragmatic hernia, subcutaneous hemorrhage, and bone marrow emboli. In summary, 73% (190 of 262) of WF bats had lesions consistent with traumatic injury. The authors then examined for ruptured tympana, a sensitive marker of barotrauma in humans. BC bats had only 1 case (2%, 1 of 42), but this was attributed to concurrent cranial fractures, whereas WF bats had a 20% (16 of 81) incidence. When cases with concurrent traumatic injury were excluded, this yielded a small fraction (6%, 5 of 81) of WF bats with lesions possibly consistent with barotrauma etiology. Forensic pathology examination of the data strongly suggests that traumatic injury is the major cause of bat mortality at wind farms and, at best, barotrauma is a minor etiology.

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Section: Discussionmentioning

confidence: 99%

A Forensic Investigation Into the Etiology of Bat Mortality at a Wind Farm: Barotrauma or Traumatic Injury?

et al. 2012

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“…The ear is the most vulnerable and typically the first organ to incur injury from a blast (or pressure) wave [5][6][7]. Although hearing protection devices are available in the combat theater, recent anecdotal reports indicate some troops decline to wear hearing protection for fear of reduced situational awareness on the battlefield [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Blast-related ear injuries often present as damage to the sensitive structures of the inner and middle ear, such as the cochlea, ossicular chain, tympanic membrane (TM), and vestibular system [5,[13][14]. Damage to these components of the auditory system may result in transient or permanent impairment, such as hearing loss and tinnitus (ringing in the ears) [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Blast-related ear injuries among U.S. military personnel

et al. 2013

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Blast-related ear injuries are a concern during deployment because they can compromise a servicemember's situational awareness and adversely affect operational readiness. The objectives of this study were to describe blast-related ear injuries during Operation Iraqi Freedom, identify the effect of hearing protection worn at the point of injury, and explore hearing loss and tinnitus outcomes within one year after injury. The Expeditionary Medical Encounter Database was used to identify military personnel who survived blast-related injury, and it was linked with outpatient medical databases to obtain diagnoses of hearing loss and tinnitus. The prevalence of ear injuries was 30.7% (1,223 of 3,981). The most common ear injury diagnoses were "inner or middle ear injury involving tinnitus" and tympanic membrane (TM) rupture. Hearing protection reduced the odds of ear injury involving tinnitus. Personnel with TM rupture had higher odds of hearing loss (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 5.04-8.78) and tinnitus outcomes (OR = 4.34, 95% CI = 3.12-6.04) than those without TM rupture. Ear injuries and hearing impairment are frequent consequences of blast exposure during combat deployment. Hearing protection is warranted for all servicemembers at risk of blast exposure.

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“…In addition to otoscopy, patients should be examined for bilateral hearing acuity, for sensorineural hearing loss with a tuning fork, and for facial nerve injury. 29 Long-term follow-up, to include audiometry, should be performed for all persons exposed to explosions. 26 Blast Lung.…”

Section: Rationalementioning

confidence: 99%

“…44 Neurovascular Syndrome. Seen in high-dose exposures (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Neurovascular syndrome can present as cognitive and neurologic deficits, ataxia, seizures, and hypotension all from cerebral edema.…”

Section: Acute Radiation Syndromementioning

confidence: 99%