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Editorial: Boston Marathon Bombings: Unprecedented Ear Injuries Inspire Multicenter Study

Remenschneider, Aaron MD, MPH; Lee, Daniel MD; Quesnel, Alicia MD

doi: 10.1097/01.HJ.0000432404.08326.ac
Editorial
Free

Dr. Remenschneider is a fourth-year resident in the Harvard Combined Program in Otolaryngology.

Dr. Lee is assistant professor of otology and laryngology at Harvard Medical School.

Dr. Quesnel is instructor in otology and laryngology at Harvard Medical School.

All three authors are also affiliated with the Massachusetts Eye and Ear Infirmary in Boston.

On the evening of April 15th, the emergency department at Massachusetts Eye and Ear Infirmary was full. Patients who were cleared of other major medical trauma next door at Massachusetts General Hospital arrived to be evaluated for ear pain, hearing loss, and other head and neck injuries. Over 250 people were maimed by the dual blasts at the Boston Marathon earlier in the day, and we were seeing the aftermath.

Figure. Aa

Figure. Aa

Most patients had hearing loss, tinnitus, and mild disequilibrium. On exam, they had tympanic membrane perforations, large and small. Pieces of metallic shrapnel were identified and carefully removed from patients' faces, necks, and arms. Audiograms revealed both conductive and sensorineural hearing loss, often worse in the ear facing the blast. Careful eversion of perforated drum edges was performed, and selected patients with sensorineural hearing loss were treated with oral steroids.

Later in the evening, the otolaryngology team visited patients with significant soft tissue and limb injury in the intensive care unit—proximity to the blast seemed to predict substantial tympanic membrane loss. Examination of patient after patient continued through the night and into the next day.

Figure. Da

Figure. Da

In the ensuing weeks, we have seen dozens of these victims in our clinic and emergency room. Our treatment recommendations were based on experience with traumatic perforations from other causes, clinical and scientific literature on noise-induced hearing loss, and recommendations from the military literature and military colleagues. Whether differences exist in the expected outcomes between civilians and military personnel is unknown.

Fortunately, blast injuries to the ear are rare occurrences in our society. The otologic morbidity from this single event was unprecedented for our city, and it has led otolaryngologists and audiologists from each of Boston's major medical centers to come together in an effort to study the nature of patient injuries and to document their outcomes over time.

Figure

Figure

The primary aim of the study is to correlate tympanic membrane perforation size with rates of healing, including the success of tympanoplasty. Secondary aims include understanding the effect of steroids on sensorineural hearing loss after acoustic trauma, and relating distance from the blast to sensorineural hearing loss and tympanic membrane perforation.

Massachusetts Eye and Ear Infirmary, Beth Israel Deaconess Medical Center, Boston Children's Hospital, Boston Medical Center, Brigham and Women's Hospital, Harvard Vanguard Medical Associates, and Tufts Medical Center all saw patients affected by the events of April 15 and agreed to pool data for meaningful analysis. Standardized data collection forms with serial audiograms will comprise the core data set. We have evaluated over 100 patients, and we expect to enroll and follow these individuals over the next twelve months. Data collection has already begun in this multicenter study.

In our effort to provide the highest quality of care to the Boston Marathon bombing victims, we must acknowledge what we do not know about blast-related ear injury. We hope to learn more about the consequences of acoustic trauma through this research, and we appreciate all we have already learned from these individuals about inner strength and resilience.

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