Fausti Stephen A, Wilmington Debra J, Gallun Frederick J, Myers Paula J, Henry James A
Department of Veterans Affairs (VA) Rehabilitation Research and Development Service, National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR 97239, USA.
J Rehabil Res Dev. 2009;46(6):797-810. doi: 10.1682/jrrd.2008.09.0118.
The dramatic escalation of blast exposure in military deployments has created an unprecedented amount of traumatic brain injury (TBI) and associated auditory impairment. Auditory dysfunction has become the most prevalent individual service-connected disability, with compensation totaling more than 1 billion dollars annually. Impairment due to blast can include peripheral hearing loss, central auditory processing deficits, vestibular impairment, and tinnitus. These deficits are particularly challenging in the TBI population, as symptoms can be mistaken for posttraumatic stress disorder, mental-health issues, and cognitive deficits. In addition, comorbid factors such as attention, cognition, neuronal loss, noise toxicity, etc., can confound assessment, causing misdiagnosis. Furthermore, some auditory impairments, such as sensorineural hearing loss, will continue to progress with age, unlike many other injuries. In the TBI population, significant clinical challenges are the accurate differentiation of auditory and vestibular impairments from multiple, many times overlapping, symptoms and the development of multidisciplinary rehabilitation strategies to improve treatment outcomes and quality of life for these patients.
军事部署中爆炸暴露情况的急剧升级导致了前所未有的创伤性脑损伤（TBI）及相关听觉障碍。听觉功能障碍已成为最普遍的与服役相关的个体残疾，每年的赔偿总额超过10亿美元。爆炸造成的损伤可包括外周听力损失、中枢听觉处理缺陷、前庭损伤和耳鸣。这些缺陷在创伤性脑损伤人群中尤其具有挑战性，因为症状可能被误诊为创伤后应激障碍、心理健康问题和认知缺陷。此外，注意力、认知、神经元损失、噪声毒性等共病因素会干扰评估，导致误诊。此外，一些听觉障碍，如感音神经性听力损失，与许多其他损伤不同，会随着年龄的增长而持续进展。在创伤性脑损伤人群中，重大的临床挑战是从多种且常常相互重叠的症状中准确区分听觉和前庭损伤，以及制定多学科康复策略以改善这些患者的治疗效果和生活质量。
