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Otologic outcomes after blast injury: the Boston Marathon experience
Aaron K Remenschneider1, Sarah Lookabaugh, Avner Aliphas
1*Department of Otology and Laryngology, Harvard Medical School; †Department of Otolaryngology, Massachusetts Eye and Ear Infirmary; ‡Department of Otolaryngology, Massachusetts General Hospital; §Department of Otolaryngology Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine; ∥Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital; ¶Department of Otolaryngology Head and Neck Surgery, Tufts Medical Center, Tufts University School of Medicine; #Division of Otolaryngology, Department of Surgery, Beth Israel Deaconess Medical Center; ††Department of Audiology, Massachusetts Eye and Ear Infirmary; and §§Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.
Insights
Blast injuries from the Boston Marathon bombings caused significant ear problems, including perforated eardrums and persistent hearing loss. Many patients experienced ongoing otologic morbidity requiring continued care.
Area of Science:
- Traumatic injury
- Otolaryngology
- Public health
Background:
- Otologic trauma was a frequent injury following the 2013 Boston Marathon bombings.
- Understanding the long-term effects of blast-related ear injuries is crucial.
Purpose of the Study:
- To describe the otologic morbidity resulting from the Boston Marathon bombing.
- To report on the early outcomes of patients with blast-related ear injuries.
Main Methods:
- A multi-institutional prospective cohort study was conducted.
- Patients with otologic complaints post-bombing were evaluated using symptom assessments, quality-of-life questionnaires, and audiograms.
- Otologic evaluations and treatments, including tympanoplasty, were reviewed.
Main Results:
- Ninety percent of hospitalized patients had tympanic membrane perforation; proximity to the blast and non-otologic injury were predictors.
- Spontaneous healing occurred in 38% of cases, with an 86% success rate for tympanoplasty.
- Persistent hearing loss, tinnitus, and difficulty hearing in noise affected patients, impacting their quality of life.
Conclusions:
- Blast-related otologic injuries are a significant cause of ongoing morbidity after the Boston Marathon bombings.
- Continued follow-up and care are necessary for this patient population.
Objective:
Otologic trauma was the most common physical injury sustained after the April 15, 2013, Boston Marathon bombings. The goal of this study is to describe the resultant otologic morbidity and to report on early outcomes.
Study Design:
Multi-institutional prospective cohort study.
Methods:
Children and adults seen for otologic complaints related to the Boston Marathon bombings comprised the study population. Participants completed symptom assessments, quality-of-life questionnaires, and audiograms at initial and 6-month visits. Otologic evaluation and treatment, including tympanoplasty results, were reviewed.
Results:
More than 100 patients from eight medical campuses have been evaluated for blast-related otologic injuries; 94 have enrolled. Only 7% had any otologic symptoms before the blasts. Ninety percent of hospitalized patients sustained tympanic membrane perforation. Proximity to blast (RR = 2.7, p < 0.01) and significant nonotologic injury (RR = 2.7, p < 0.01) were positive predictors of perforation. Spontaneous healing occurred in 38% of patients, and tympanoplasty success was 86%. After oral steroid therapy in eight patients, improvement in hearing at 2 and 4 kHz was seen, although changes did not reach statistical significance. Hearing loss, tinnitus, hyperacusis, and difficulty hearing in noise remain persistent and, in some cases, progressive complaints for patients. Otologic-specific quality of life was impaired in this population.
Conclusion:
Blast-related otologic injuries constitute a major source of ongoing morbidity after the Boston Marathon bombings. Continued follow-up and care of this patient population are warranted.