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Otologic Outcomes After Blast Injury: The Boston Marathon Experience

Remenschneider, Aaron K.*†‡; Lookabaugh, Sarah; Aliphas, Avner§; Brodsky, Jacob R.*∥; Devaiah, Anand K.§; Dagher, Walid; Grundfast, Kenneth M.§; Heman-Ackah, Selena E.*#; Rubin, Samuel§; Sillman, Jonathan; Tsai, Angela C.§; Vecchiotti, Mark; Kujawa, Sharon G.*††; Lee, Daniel J.*†‡§§; Quesnel, Alicia M.*†‡

doi: 10.1097/MAO.0000000000000616
Middle Ear and Mastoid Disease

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.

*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.

Address correspondence and reprint requests to Alicia Quesnel, M.D., 243 Charles St., Boston, MA 02114, U.S.A.; E-mail:

The authors disclose no conflicts of interest.

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company