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'Silent Trauma': Hearing Loss, Ear Damage Linger Long After Marathon Bombing

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After two bombs exploded at the Boston Marathon in April of last year, the initial focus was on the lives and the multiple limbs lost in the attack. But ear damage was the most common physical injury. A new report finds that many victims are still suffering from hearing loss and ear damage related to the blasts.

A team of Boston researchers report on the lingering impact of those ear and hearing problems in a new study published in the journal Otology and Neurotology.

The report's conclusion

Blast-related otologic injuries constitute a major source of morbidity after the Boston Marathon bombings. Orthopedic and soft tissue trauma was sustained by many, but far more incurred ear-related damage. This represents much of the silent trauma that requires continued evaluation and treatment...

More specifically:

Among the 94 study participants, researchers found that 90 percent of the hospitalized patients sustained "tympanic membrane perforation," basically a ruptured ear drum, following the bombings. From the study:

Proximity to blast and significant nonotologic injury were positive predictors of perforation. Spontaneous healing occurred in 38% of patients, and tympanoplasty success was 86%...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.

Notably, it took many blast victims some time to realize the extent of their hearing problems, researchers report. Alicia M. Quesnel, an otologic surgeon at Massachusetts Eye and Ear and Harvard Medical School, a senior author of the study told The Washington Post:

"I saw patients who were traumatized by what had just happened, and there was a lot going on emotionally," Quesnel said. "We were seeing people coming into the clinic in the days and weeks after the bombing. They realized that they can't hear very well."

"A bomb going off — that loudness results in some temporary deafening. It may have taken people a few days or weeks to realize 'I can't hear from one ear or both ears.'"

Here's more from the Mass. Eye and Ear news release:

After two bombs exploded near the finish line of the Boston Marathon on April 15, 2013, acute trauma to the ears - such as ruptured eardrums - was immediately apparent to those caring for the victims. However, the full extent of the effect on the ears and hearing of victims was not fully recognized for weeks. In the end, more than 100 patients were evaluated for blast-related otologic injuries.

Almost immediately, Boston researchers set out to detail the types of otologic injury and report on the outcomes of patients undergoing otologic treatment. Ninety-four of the injured individuals elected to enroll in an eight-institution study that began before the end of April 2013 through the efforts of Harvard Catalyst, the clinical and translational science center that facilitated a framework for Harvard Medical School-affiliated institutions to speed the review of human studies. The research findings will be reported in the December 2014 issue of the journal Otology & Neurotology and are available online now.

"The purpose of this report is describe the burden of otologic injury following the Boston Marathon Bombings and to understand how otologic trauma has affected patients' quality of life," said lead author Aaron Kyle Remenschneider, M.D., physician-researcher affiliated with Massachusetts Eye and Ear and Harvard Medical School, who was Mass. Eye and Ear's chief resident at the time of the bombings and cared for many of the victims.

Using a multi-institutional, prospective cohort study, researchers from eight medical campuses evaluated children and adults seen for otologic complaints related to the Boston Marathon bombings. Participants completed an otologic/noise exposure history, a current symptom assessment and quality of life questionnaires at initial visits and six months later. Records from otologic evaluation and audiometry were reviewed.

"Of the 94 patients that enrolled, only 7 percent had any otologic symptoms prior to the blasts," said Alicia Quesnel, M.D., senior author and otologic surgeon at Mass. Eye and Ear and Harvard Medical School, who continues to provide care for these patients. "All patients evaluated reported hearing loss or tinnitus."

Seventy-nine patients had initial audiograms available for review that revealed conductive, sensorineural or mixed hearing losses. Ninety percent of hospitalized patients suffered ruptured eardrums. Those who were closest to the blasts and who had other significant injuries also experienced ruptured eardrums. Twenty-one non-healing ear drum perforations were surgically repaired with closure of the perforation in all but two.

"Hearing, tinnitus and dizziness-related quality of life was found to be impaired in these patients," Dr. Quesnel continued. "Our conclusion is that blast-related ear injuries constitute a major source of ongoing morbidity following the bombings. Patient symptoms continue to evolve and many patients have 'hidden hearing loss,' which may not be apparent on routine hearing tests. There is a definite need for long-term follow-up assessments to ensure that patients receive appropriate testing and treatment."

Rachel Zimmerman Twitter Health Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for Bostonomix.

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