ENT Updates

Abstract

Objective: This study aims to examine what ear pathologies may occur in law-enforcement officials exposed to the effects of improvised explosive devices in regions where high levels of terrorist activity are expected. The issues faced by ENT and head and neck surgeons in treating such injuries are also examined.

Methods: A retrospective review of examination findings and initial treatment offered was performed on clinical records written by specialists in Emergency Medicine, General Surgery, ENT and Head and Neck Surgery during a particular period (14/3/2016 to 25/7/2016) when a curfew was in operation. The records were taken from Nusaybin State Hospital. Some 260 individuals were included in the review, all of whom had ear problems related to exposure to an explosion. The particulars of the trauma incurred, the presenting complaint, examination findings, and initial surgical and medical treatment offered were determined for each case.

Results: In 224 out of 260 cases, a primary explosion injury was recorded. The most frequently documented symptoms were tinnitus and loss of hearing. On physical examination, 25 individuals had traumatic perforation of the tympanic membrane. 12 cases featured nystagmus and dizziness and fistula testing was positive in 2 cases, possibly as a result of a perilymph fistula. In case where abrupt hearing loss was apparent on audiological testing, intravenous methylprednisolone was administered at a dosage of 1mg/kg. Cases of multiple trauma were referred onto more specialised clinical units. For cases where hearing loss was mild and the only symptom, the treatment was a reducing dose of oral methylprednisolone over twelve days. Thirty-six individuals were diagnosed with secondary trauma from the explosion. Such trauma included soft tissue and bony injury in the auricular, pre- and post-auricular regions, and was treated by surgery.

Conclusion: Ear trauma secondary to improvised explosive devices is a common injury in law-enforcement officials. In individuals exposed to such hazards, symptoms of hearing problems should be sought, otoscopic and vestibular examination and audiological testing should be carried out at an early stage, and the patient should be referred to an ENT or Head and Neck Surgeon.