A lightning strike causing a cholesteatoma: a unique form of otologic blast injury.

OBJECTIVE

We present a case of a middle-aged male struck by lightning while walking in a parking lot. Assessment of the patient's injuries demonstrated common sequelae of an otologic blast injury. Review of this case should prepare the otolaryngologist to identify and manage otologic blast injuries regardless of their etiology.

METHODS

Case study and literature review

CASE REPORT

The patient presented to a level 1 trauma and burn center with a ruptured tympanic membrane, otalgia, mixed hearing loss, dizziness, and tinnitus. After 3 months of observation, the patient's tympanic membrane perforation demonstrated little spontaneous closure. Additionally, he was noted to have formation of a posttraumatic cholesteatoma in the posterior-superior mesotympanum. Over-under tympanoplasty with excision of the cholesteatoma was successful, and the ossicular chain remained intact. The patient underwent vestibular therapy for an ipsilateral uncompensated vestibular weakness. His dizziness resolved, allowing him to return to full employment. The patient's final audiogram demonstrated normal hearing thresholds sloping to a mild mixed hearing loss in the high frequencies, and the tinnitus reduced significantly in intensity but did not resolve.

CONCLUSION

The patient's injury pattern clearly resulted from the damaging effects of the shock wave generated by the lightning bolt, which impacted the patient's thorax. Management of his otologic care was conducted after practices developed for otologic blast injury and resulted in his being able to return to his primary occupation.