Seared in the public's consciousness over the past several days are reports and images of the grievous leg injuries suffered by many of the Marathon bombing victims. In fact, there have been at least 13 amputations since the attacks. But many people hurt in the attack also received serious ear injuries, including some that have affected their hearing.
Dr. Alicia Quesnel, an ear specialist at the Massachusetts Eye and Ear Infirmary in Boston, has treated more than a dozen bombing victims with hearing-related injuries. She spoke to WBUR's All Things Considered host Sacha Pfeiffer and described the wounds she is seeing.
Dr. Alicia Quesnel: Most of the injuries that I've seen have been problems with hearing loss and then problems with ruptured ear drums or holes in the ear drums that have been created literally from the blast traumas. And there have been a lot of patients who, unfortunately, are missing parts of the ear drums or there are large tears in the ear drums. That's mostly what we've been seeing, and they have hearing loss as a result of that.
Sacha Pfeiffer: Would you walk through the anatomy of an ear or an ear drum? There's some membrane, a protective membrane? So describe what the injuries can be to that anatomy.
If you think about the ear from the outside in, you have what we call the oracle or the external part of the ear, and some patients have burns or trauma to the outside part of the ear. There's the ear canal, and some patients have had lacerations or cuts or injuries we're seeing in the external canal that need to be cleaned out and removed.
As you keep going inwards, the hearing works by vibrating an ear drum and three little bones that need to vibrate to transmit sound energy into the inner ear. We've seen tears in the ear drum and then hearing loss related to the inner ear structure also related to the impact and, literally, the loud, tremendous sound exposure.
So some of the injuries are because of lacerations caused by foreign objects or shrapnel, but some are from the sound of the explosion itself?
How does that injury happen and what is the damage being caused to an ear by a noise that's basically too loud?
Either literally direct blast trauma to the ear drum, which has caused it to rupture, so literally the mechanical force of a loud sound can cause the ear drum to rupture or tear. And then, in addition, patients can also develop what we call a sensorineural hearing loss, or an inner ear hearing loss, related to the loud sound and the impact of that loud sound onto the inner ear.
For some of these patients, they may have experienced a hearing loss that lasted for a half-hour, an hour, a couple hours, and recovered after that. Sometimes it can last up to a week. But what we know from a lot of research is actually that that can have a long-term effect on hearing down the road in terms of what their hearing ends up being like from acoustic trauma.
How do you treat these injuries?
It depends on the specific nature of the injury. But, for example, we talked about external canal lacerations. That would really just be cleaning it out and starting some antibiotic ear drops to make sure patients don't develop an infection related to that. With the ear drums that have been ruptured or have holes in them, sometimes those will heal on their own and, actually, with traumatic perforations, which these are, they may heal on their own. It really depends on the size of the hole that's created. Larger holes are not as likely to heal on their own. Very small perforations are quite likely to heal on their own. When they don't heal on their own, down the road, a couple months down the road, if they haven't healed on their own we can actually fix this surgically and repair the hearing in that way.
But there could be some patients from Monday whose hearing will never be the same?
Right. There could be some patients with sensorineural hearing loss that won't recover.
In any normal situation these would be considered very serious injuries, but because they're being viewed relative to leg amputations some people may not realize that these injuries are as serious as they are. Do you think that's fair to say?
I think that's certainly fair to say. You have to put it into context in terms of what else the patient is going through. These patients are devastated from many other injuries, and both emotionally and physically. And certainly this is one of their issues that we're dealing with and trying to help them in any way that we can with that.
Oftentimes we're able to provide some good news, which is that for most of these patients I think they're going to end up having a problem with the mechanical part of their hearing, which is the ear drum, which will either heal on its own or be something that we can actually fix surgically rather than end up with a lot of long-term issues from it.
Are there some patients who are not only dealing with leg injuries but also ear injuries?
That's right. A lot of the patients have multiple wounds or issues from the trauma.
This program aired on April 18, 2013.