Ballivet de Régloix Stanislas, Crambert A, Maurin O, Lisan Q, Marty S, Pons Y
Department of ENT-Head and Neck Surgery, Military Training Hospital Percy, Clamart, France.
Department of ENT-Head and Neck Surgery, Military Training Hospital Val de Grâce, Paris, France.
J R Army Med Corps. 2017 Oct;163(5):333-338. doi: 10.1136/jramc-2016-000733. Epub 2017 Feb 16.
Blast injuries in modern warfare are common, and the ear is often affected as it is an effective pressure transducer. This study aimed to evaluate military blast injuries of the ear.
From May 2002 to October 2014, all patients referred to two military hospitals near Paris, France following exposure to massive explosions were analysed.
Among the 41 patients (82 ears), 36 of them reported tinnitus, 25 hearing loss, 14 earache and 8 vertigo. It was noted that 44% of the patients had tympanic membrane perforations and that this was bilateral in two-thirds of the cases. The hearing loss in 29% of the cases was pure sensorineural, in 55% it was mixed and in 15% it was a pure conductive hearing loss. There was no correlation between the impact of middle ear lesions and the severity of the inner ear injury. Three patients had a pharyngolaryngeal blast injury detected on the battlefield associated with blast lung injury, but only two of them had tympanic perforations. Nine tympanoplasty procedures were performed, of which 44% succeeded in sealing the perforation.
Blast injuries of the ear are characterised by significant functional signs and are not correlated to otoscopic examinations. Sensorineural hearing loss is almost immediately final. When deciding on initial management, the status of the tympanic membrane does not provide any information about the risk of a primary blast injury of the lung; laryngeal nasofibroscopy seems a more relevant screening test.
现代战争中的爆炸伤很常见，耳朵因其是有效的压力感受器而常受影响。本研究旨在评估耳部的军事爆炸伤。
对2002年5月至2014年10月间，在法国巴黎附近两家军事医院就诊的所有因暴露于大规模爆炸而受伤的患者进行分析。
在41例患者（82只耳朵）中，36例报告有耳鸣，25例有听力损失，14例有耳痛，8例有眩晕。注意到44%的患者有鼓膜穿孔，其中三分之二为双侧穿孔。29%的病例听力损失为纯感音神经性，55%为混合性，15%为纯传导性听力损失。中耳病变的影响与内耳损伤的严重程度之间无相关性。3例患者在战场上被检测出有咽喉部爆炸伤并伴有爆震性肺损伤，但其中只有2例有鼓膜穿孔。进行了9次鼓膜成形术，其中44%成功封闭了穿孔。
耳部爆炸伤具有明显的功能体征，与耳镜检查结果无关。感音神经性听力损失几乎立即成为永久性的。在决定初始治疗时，鼓膜的状况并不能提供有关肺部原发性爆炸伤风险的任何信息；喉鼻纤维镜检查似乎是一种更相关的筛查测试。
