Otologic Outcomes After Blast Injury: The Brussels Bombing Experience

After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients.

Prospective cohort study.

Tertiary referral center.

Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included.

All included patients were treated with systemic corticosteroid therapy, concurrent hyperbaric oxygen therapy (HBOT) was advised to each and every included patient.

Participants underwent a routine otologic work-up including otoscopy, liminal audiometry, and subjective outcome measures related to tinnitus at baseline and at follow-up. Primary outcome was to describe the otologic morbidity after acute acoustic trauma (AAT). Secondary outcome was to evaluate the recovery of hearing loss, subjective symptoms, and tympanic membrane perforations.

Fifty-six patients were included in our population with an average age of 27 ± 13 years, and 46% women/54% men. Thirty-two patients reported subjective hearing loss, 45 reported tinnitus, 45 reported a feeling of pressure in the ear, 2 patients experienced vertigo, and 18 patients reported hyperacusis. Otoscopic examination revealed three tympanic membrane perforation (TMP). Sensorineural hearing loss (SNHL) was observed in 41% (n = 23) and mixed hearing loss in 3.6% (n = 2). No conductive hearing loss (CHL) was observed. Follow-up was obtained in 76.8%, with the last follow-up available at 47 ± 74 days. Two perforations closed spontaneously, while one persistent perforation was successfully reconstructed with complete air-bone gap closure. There was a significant improvement in subjective symptoms. SNHL improvement was observed in 52.6% (10/19), mixed hearing loss improved in both patients. Improvement in hearing thresholds was seen in patients treated with steroids and in those treated with steroids and HBOT, there was no significant difference in the degree of improvement between these two groups.

Blast-related otologic injuries have a significant impact on morbidity. Comprehensive otologic evaluation and state-of-the-art treatment may lead to a significant improvement in symptoms and hearing loss.