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Ulus Travma Acil Cerrahi Derg. 2018 Sep;24(5):450-455. doi: 10.5505/tjtes.2017.60649.

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

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Department of Otolaryngology and Head and Neck Surgery, Gülhane Training and Research Hospital, Ankara-Turkey.



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.


The medical data of patients admitted to an operational field hospital emergency room with injuries related to highenergy 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.


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).


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.

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