Binaural Tympanic-Membrane Perforations after Blast Injury.
A 30-year-old man presented to the emergency department with new-onset hearing loss and tinnitus in both ears after a blast injury. While at a wedding that included celebratory fireworks, he had been standing near a sand-filled mortar when it accidentally ignited. Otoscopy revealed multiple perforations of both tympanic membranes (Panel A shows the right ear, and Panel B the left ear). Audiometry revealed mild conductive hearing loss (20-dB hearing level) and moderate sensorineural hearing loss at 4000 Hz (40-dB hearing level) in each ear. Perforation of the tympanic membrane can occur after a high-energy blast injury. Sharp-edged radial or triangle-shaped perforations and bleeding margins are likely to indicate a traumatic origin of a tympanic-membrane perforation. Small perforations are often managed with observation alone, but larger perforations may be patched to prevent water from entering the middle ear and to improve healing. If sudden hearing loss after a blast injury is accompanied by acute vertigo with nystagmus, exploration of the middle ear can be useful to rule out fistula to the inner ear. The patient underwent patching of the perforations. Three months later, his audiographic results had normalized, and otoscopy revealed healed eardrums in both ears.