Retrospective analyses of high-energy explosive device-related injuries of the ear and auricular region: experiences in an operative field hospital emergency room

BACKGROUND: With the changing conditions of terrorism, particularly in urban areas, high-energy explosive devices such as improvised explosive devices (IEDs) and projectile missiles (PMs) are frequently used. Traumas caused by these devices particularly affect the maxillofacial region and typically lead to otologic problems. In this study, we aimed to evaluate otologic complaints, otoscopic and auricular examinations, and tuning-fork tests of patients who were exposed to high-energy blast-related injuries and perform a comparison between trauma patients injured by IEDs and PMs.
METHODS: The medical data of patients admitted to an operational field hospital emergency room with injuries related to high-energy explosive devices such as IEDs and PMs between July 27, 2015 and July 22, 2016 was reviewed. The hearing impairment, tinnitus, otologic examination, auricular region examination, and tuning-fork tests of all patients were evaluated. The otologic evaluation records of the patients (n=86) were evaluated using a scoring system established by the authors. The patients were categorized into two groups according to the device causing the injury: IEDs in group I and PMs in group II.
RESULTS: A total of 241 combatants were injured by high-energy explosive devices. All patients were male with a mean age of 30.2 years (range, 20–54). Of these, 86 had hearing impairments that were detected by tuning-fork tests. Of those, 50 were injured by IEDs and 36 by PMs. Of the 86 patients, 18 had traumatic tympanic membrane perforation, and of those, 6 patients were injured by IEDs and 12 by PMs. Further, 68 of the 86 patients had sensorineural hearing loss, and of those, 44 were injured by IEDs and 24 by PMs. There was a statistically significant difference between the IED and PM groups according to otologic evaluation score (p=0.044).
CONCLUSION: This study demonstrates that PMs can have a large impact on the human ear and may cause more severe otologic manifestations among combatants than those caused by IEDs. The early and accurate evaluation of patients exposed to high-energy explosive devices in an operational field is important for the appropriate management of these patients.

Kulak ve aurikular bölgenin yüksek enerjili patlayýcýlar kaynaklý yaralanmalarýnýn geriye dönük analizi: Operasyon saha hastanesi acil servis deneyimleri

AMAÇ: Terörizmin koþullarý deðiþtikçe, özellikle kentsel alanlarda, el yapýmý patlayýcýlar gibi yüksek enerjili patlayýcý maddeler sýklýkla kullanýlmaktadýr. Bu travmalar özellikle maksillofasiyal bölgeyi etkiler ve genellikle otolojik problemler yaratýrlar. Bu çalýþma, yüksek enerjili patlamayla iliþkili yaralanmalara maruz kalan hastalarýn otolojik þikayetlerini, otoskopik ve auriküler muayene ve diyapozon testlerini deðerlendirmeyi ve otolojik deðerlendirme skorlarýna dayanarak el yapýmý patlayýcýlar (ÝED) ve rokete (PM) baðlý yaralanan travma hastalarý arasýnda bir karþýlaþtýrma yapmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: 27 Temmuz 2015 ile 22 Temmuz 2016 tarihleri arasýnda el yapýmý patlayýcý EYP ve roket PM nedeniyle yaralanan ve operasyonel saha hastanesi acil servisine baþvuran 241 hastanýn týbbi verileri gözden geçirildi. Tüm hastalar için iþitme bozukluðu, kulak çýnlamasý þikayetleri, otolojik muayene, aurikuler bölgede muayene ve diyapozon testleri yapýldý ve otolojik problemi olan hastalarýn (n=86) otolojik deðerlendirme skoru kayýtlarý deðerlendirildi. Hastalar yaralanmaya neden olan cihaza göre iki gruba ayrýldý: Grup I’de ÝED, grup II’de PM’ler.
BULGULAR: Ýki yüz kýrk bir savaþçý, yüksek enerjili patlayýcýlarla yaralanmýþtý. Tüm hastalar erkekti ve yaþ ortalamasý 30.2 idi (aralýk 20–54). Ýki yüz kýrk birinden 86’sýnda iþitme þikayeti mevcuttu. Bunlarýn 50’sinin ÝED tarafýndan yaralanmasý ve 36’sý PM tarafýndan yaralanmýþtý. Seksen altý hastanýn 18’inde travmatik timpanik membran perforasyonu vardý ve altý hasta ÝED, 12 hasta PM nedeniyle yaralanmýþtý. Seksen altý hastanýn 68’inde sensorinöral iþitme kaybý vardý ve bu hastalarýn 44’ünde ÝED yaralanmasý ve 24’ünde PM yaralanmasý vardý. Otolojik deðerlendirme skoruna göre ÝED ve PM gruplarý arasýnda istatistiksel olarak anlamlý farklýlýk vardý (p=0.044).
TARTIÞMA: Bu çalýþma, roket yaralanmalarýnýn insan kulaðýnda daha büyük bir etkiye neden olabileceðini ve travma hastalarý arasýnda el yapýmý patlayýcýlara göre daha þiddetli otolojik bulgular yarattýðýný gösterdi. Operasyonel saha hastanesi gibi acil müdahale alanlarýnda otolojik yaralanmaya maruz kalan hastalarýn erken ve doðru deðerlendirilmesi ve uygun tedavisi çok önemlidir.