Ritenour Amber E, Wickley Aaron, Ritenour Joshua S, Kriete Brian R, Blackbourne Lorne H, Holcomb John B, Wade Charles E
United States Army Institute of Surgical Research, San Antonio, Texas, USA.
J Trauma. 2008 Feb;64(2 Suppl):S174-8; discussion S178. doi: 10.1097/TA.0b013e318160773e.
Tympanic membrane perforation is the most common primary blast injury in the current conflicts and occurs in approximately one tenth of service members wounded by combat explosions. We wanted to determine the severity of perforation and its effect on hearing and combat readiness.
This analysis is a retrospective study of US service members injured in combat explosions in Afghanistan or Iraq and treated at our institution between March 2003 and July 2006. Data captured included location and grade of perforation, symptoms, healing rates, audiogram results, need for hearing aids, and loss of eligibility for military service.
Of 436 explosion-wounded patients admitted to our facility, 65 (15%) patients had tympanic membrane perforation diagnosed by the otolaryngology service. A total of 97 tympanic membrane perforations occurred among 65 patients. The average surface area involved was 41% +/- 32% (right) and 35% +/- 34% (left). More than one third of perforations were grade 4. The most common locations were central and anterior-inferior. Most (83%) patients reported symptoms, most commonly diminished hearing (77%) and tinnitus (50%). Outcome data were available for 77% of perforations. Spontaneous healing occurred in 48%. The remainder (52%) had surgical intervention. The most common audiogram abnormality was mild high frequency hearing loss. Ultimately, three patients (5%) required hearing aids and one discharge from military service.
Tympanic membrane perforation occurs in 16% of explosion-injured patients. Most patients are symptomatic and many have large perforations requiring operative intervention. Long-term hearing loss is uncommon but does impact ability to continue military service.
鼓膜穿孔是当前冲突中最常见的原发性爆炸伤，在因战斗爆炸受伤的军人中约占十分之一。我们希望确定穿孔的严重程度及其对听力和作战准备的影响。
本分析是一项对2003年3月至2006年7月间在阿富汗或伊拉克因战斗爆炸受伤并在我们机构接受治疗的美国军人的回顾性研究。收集的数据包括穿孔的位置和分级、症状、愈合率、听力图结果、对助听器的需求以及丧失服役资格情况。
在我们机构收治的436名爆炸伤患者中，65名（15%）患者经耳鼻喉科诊断为鼓膜穿孔。65名患者共发生97处鼓膜穿孔。受累平均表面积右侧为41%±32%，左侧为35%±34%。超过三分之一的穿孔为4级。最常见的位置是中央和前下方。大多数（83%）患者有症状，最常见的是听力减退（77%）和耳鸣（50%）。77%的穿孔有转归数据。48%的穿孔自行愈合。其余（52%）接受了手术干预。最常见的听力图异常是轻度高频听力损失。最终，3名患者（5%）需要佩戴助听器，1名患者丧失服役资格。
鼓膜穿孔发生于16%的爆炸伤患者中。大多数患者有症状，许多患者有较大穿孔需要手术干预。长期听力损失并不常见，但确实会影响继续服役的能力。
