Eardrum Perforation in Explosion Survivors: Is It a Marker of Pulmonary Blast Injury?,☆☆,,★★

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Abstract

Study Objectives: To determine whether isolated eardrum perforation is a marker for concealed blast lung injury in survivors of terrorist bombings. Methods: Survivors who arrived at hospitals after 11 terrorist bombings in Israel between April 6, 1994, and March 4, 1996, were examined otoscopically by ear, nose, and throat specialists. All patients with eardrum perforation underwent chest radiography and were hospitalized for at least 24 hours for observation. The clinical course and final outcome of patients with isolated perforation of the eardrums and of those with other blast injuries were surveyed. Results: A total of 647 survivors were examined; 193 (29.8%) of them sustained primary blast injuries, including 142 with isolated eardrum perforation and 51 with other forms of blast injuries (18 with isolated pulmonary blast injury, 31 with combined otic and pulmonary injuries, and 2 with intestinal blast injury). Blast lung injury was promptly diagnosed on admission by physical examination and chest radiography. No patient presenting with isolated eardrum perforation developed later signs of pulmonary or intestinal blast injury (mean 0%; 95% confidence interval, 0% to 2.7%). Conclusion: Isolated eardrum perforation in survivors of explosions does not appear to be a marker of concealed pulmonary blast injury nor of a poor prognosis. Therefore, in a mass casualty event, persons who have sustained isolated eardrum perforation from explosions may safely be discharged from the emergency department after chest radiography and a brief observation period. [Leibovici D, Gofrit ON, Shapira SC: Eardrum perforation in explosion survivors: Is it a marker of pulmonary blast injury? Ann Emerg Med August 1999;34:168-172.]

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INTRODUCTION

Terrorist bombings have become an increasing international problem threatening civilian communities worldwide. Injuries incurred in such explosions were until recently a topic of interest mainly to military physicians. Considering the increasing incidence of terrorist bombings in many countries, the typical injuries are apt to challenge medical care providers who are unaccustomed to coping with such trauma in civilian populations.

Traditionally, 4 mechanisms of injury are implicated in trauma

METHODS AND MATERIALS

Between April 6, 1994, and March 4, 1996, 11 terrorist explosions occurred in Israel, injuring a total of 770 persons, 145 of whom died. Depending on geographic location, survivors were evacuated to 17 hospitals throughout Israel (range, 1 to 6 hospitals per incident). All 11 attacks were executed by suicide terrorists who either carried the bomb on their garments or drove booby-trapped vehicles. The bombs were self-made and incorporated various explosive materials, occasionally including

RESULTS

A total of 770 persons were injured in the 11 explosions, 145 (18.8%) of whom died. Of the latter group, 123 were found dead at the scene of the explosion and 22 died from their injuries after admission to the hospital. Of the 647 persons who were admitted to hospitals, 193 (29.8%) were diagnosed as having sustained primary blast injuries, including 142 with isolated eardrum perforation and 51 with other forms of primary blast injuries.

The average age of those who sustained primary blast

DISCUSSION

The reported proportion of primary blast injuries among all types of blast injuries ranges from 2% to 76%, depending on the magnitude of the explosive charge and on-scene characteristics.4, 5 The majority of persons affected by primary blast injuries have merely perforated eardrums; life-threatening blast injuries are less common. We investigated the fate of explosion survivors in whom the only primary blast injury was eardrum perforation. We assumed that perforated eardrums may indicate a more

Acknowledgements

We wish to acknowledge all the faithful physicians and nurses who worked days and nights during these difficult times in Israel.

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Cited by (0)

From the Department of Urology, Asaf-Harofe Medical Center,Tel-Aviv University, Zerifin*;and the Department of Urologyand Office of the Assistant Director,§ Hadassah Medical Center, The Hebrew University, Jerusalem, Israel.

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Address for reprints:Dr Dan Leibovici, Department of Urology, Asaf-Harofe Medical Center, Zerifin 70300, Israel.

0196-0644/99/$8.00 + 0

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