Tympanoplasty for blast-induced perforations: the Walter Reed experience

To review our tympanoplasty results for blast-induced tympanic membrane perforations and evaluate the association of various clinical factors with surgical success.

Case series with chart review.

Two tertiary military healthcare institutions.

This is a retrospective review of all patients who had nonrevision tympanoplasty during a 1-year period for blast-induced perforations by the 2 neurotologists at Walter Reed Army Medical Center and National Naval Medical Center. Various perioperative clinical factors were analyzed for relations to successful perforation closure, the need for a second operation, and postoperative hearing.

Thirty-four patients met inclusion criteria. All were male, and the average age was 24.0 years. Twenty-two (65%) were total or near-total perforations, of which 12 (35%) were repaired using lateral graft technique. The remainder had various medial graft procedures. Ossicular abnormalities were found in 6 (18%) patients. Cholesteatoma was discovered in 3 (9%) patients. Closure was complete in 82% of patients. The incomplete closures were with large perforations, those with foreign bodies (shrapnel), and in 1 with postoperative water exposure. There were no major complications, and the mean conductive hearing improvement was 11.3 dB.

Blast-induced tympanic membrane perforations are common in our population of wounded warriors. These cases are challenging because most have total or near-total perforations, the ossicles can be out of place, the blast itself can implant epithelium in the middle ear, and foreign bodies can create a hostile middle ear environment. However, given attention to detail, we found that standard tympanoplasty techniques work well.