Abstract
Purpose
Determine the prevalence of otological symptoms and tympanic membrane perforation, healing rates of tympanic membrane perforation with surgical and conservative management, and hearing function in civilian victims of terrorist explosions.
Methods
A systematic review was conducted with searches on Medline, Embase, EMCare and CINAHL for publications between the 1st January 1945 and 26th May 2023. Studies with quantitative data addressing our aims were included. This review is registered with PROSPERO: CRD42020166768. Among 2611 studies screened, 18 studies comprising prospective and retrospective cohort studies were included.
Results
The percentage of eardrums perforated in patients admitted to hospital, under ENT follow up and attending the emergency department is 69.0% (CI 55.5–80.5%), 38.7% (CI 19.0–63.0%, I2 0.715%) and 21.0% (CI 11.9–34.3%, I2 0.718%) respectively. Perforated eardrums heal spontaneously in 62.9% (CI 50.4–73.8%, I2 0.687%) of cases and in 88.8% (CI 75.9–96.3%, I2 0.500%) of cases after surgery. Common symptoms present within one month of bombings are tinnitus 84.7% (CI 70.0–92.9%, I2 0.506%), hearing loss 83.0% (CI 64.5–92.9%, I2 0.505%) and ear fullness 59.7% (CI 13.4–93.4%, I2 0.719). Symptomatic status between one and six months commonly include no symptoms 57.5% (CI 46.0–68.3%), hearing loss 35.4% (CI 21.8–51.8%, I2 0.673%) and tinnitus 15.6% (CI 4.9–40.0%, I2 0.500%). Within one month of bombings, the most common hearing abnormality is sensorineural hearing loss affecting 26.9% (CI 16.9–40.1%, I2 0.689%) of ears 43.5% (CI 33.4–54.2%, I2 0.500) of people.
Conclusion
Tympanic membrane perforation, subjective hearing loss, tinnitus, ear fullness and sensorineural hearing loss are common sequelae of civilian terrorist explosions.
Similar content being viewed by others
Data availability
Not applicable.
References
Institute for Economics and Peace (2019) Global terrorism index - measuring the impact of terrorism. Institute for Economics and Peace
Mizutari K (2019) Blast-induced hearing loss. J Zhejiang Univ Sci B 20:111–115
Singer M (2018) Otologic blast injuries. Diss Theses, Capstone Proj
Cave KM, Cornish EM, Chandler DW (2007) Blast injury of the ear: clinical update from the global war on terror. Mil Med 172:726–730. https://doi.org/10.7205/milmed.172.7.726
Cho SI, Gao SS, Xia A et al (2013) Mechanisms of hearing loss after blast injury to the ear. PLoS ONE. https://doi.org/10.1371/journal.pone.0067618
DePalma RG, Burris DG, Champion HR, Hodgson MJ (2005) Current concepts: blast injuries. N Engl J Med 352:1335–1342
Chaloner E (2005) Blast injury in enclosed spaces. Br Med J 331:119–120
Gill P, Horgan J, Lovelace J (2011) Improvised explosive device: The problem of definition. Stud Confl Terror 34:732–748. https://doi.org/10.1080/1057610X.2011.594946
Moher D, Shamseer L, Clarke M et al (2016) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Rev Esp Nutr Hum Diet 20:148–160. https://doi.org/10.1186/2046-4053-4-1
Convention of the organisation of the Islamic conference on combating International terrorism. https://www.refworld.org/docid/3de5e6646.html. Accessed 25 Jan 2020
Dekkers OM, Egger M, Altman DG, Vandenbroucke JP (2012) Distinguishing case series from cohort studies. Ann Intern Med 156:37–40. https://doi.org/10.7326/0003-4819-156-1-201201030-00006
Hoy D, Brooks P, Woolf A et al (2012) Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 65:934–939. https://doi.org/10.1016/j.jclinepi.2011.11.014
Lin L, Chu H (2020) Meta-analysis of proportions using generalized linear mixed models. Epidemiology 31:713. https://doi.org/10.1097/EDE.0000000000001232
De Régloix SB, Crambert A, Maurin O et al (2017) Blast injury of the ear by massive explosion: a review of 41 cases. J R Army Med Corps 163:333–338. https://doi.org/10.1136/JRAMC-2016-000733
Demiray E, Aydogan HC, Cavlak M et al (2022) Otologic injuries secondary to explosive attack. Indian J Otolaryngol Head Neck Surg 74:569–574. https://doi.org/10.1007/s12070-021-02384-4
Yonekawa Y, Hacker HD, Lehman RE et al (2014) Ocular blast injuries in mass-casualty incidents: the marathon bombing in Boston, Massachusetts, and the fertilizer plant explosion in West, Texas. Ophthalmology 121:1670-1676.e1. https://doi.org/10.1016/J.OPHTHA.2014.04.004
Parlak S, Beşler MS (2020) Ankara bombing: distribution of injury patterns with radiological imaging. Pol J Radiol 85:e90. https://doi.org/10.5114/PJR.2020.93394
Shariat S, Mallonee S, Kruger E et al (1999) A prospective study of long-term health outcomes among Oklahoma City bombing survivors. J Okla State Med Assoc 92:178–186
Leibovici D, Gofrit ON, Shapira SC (1999) Eardrum perforation in explosion survivors: Is it a marker of pulmonary blast injury? Ann Emerg Med 34:168–172. https://doi.org/10.1016/S0196-0644(99)70225-8
Gutierrez de Ceballos JP, Turégano Fuentes F, Perez Diaz D et al (2005) Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med 33:S107–S112. https://doi.org/10.1097/01.ccm.0000151072.17826.72
Van Campen LE, Dennis JM, Hanlin RC et al (1999) One-year audiologic monitoring of individuals exposed to the 1995 Oklahoma City bombing. J Am Acad Audiol 10:231–247. https://doi.org/10.1055/S-0042-1748495/BIB
Cohen JT, Ziv G, Bloom J et al (2002) Blast injury of the ear in a confined space explosion: auditory and vestibular evaluation. Isr Med Assoc J 4:559–562
Cudennec YF, Buffe P, Poncet J-L (1995) Otologic features and teachings of a bombing attempt. Mil Med 160:467–470. https://doi.org/10.1093/milmed/160.9.467
Helling ER (2004) Otologic blast injuries due to the Kenya embassy bombing. Mil Med 169:872–876. https://doi.org/10.7205/milmed.169.11.872
Katz E, Ofek B, Adler J et al (1989) Primary blast injury after a bomb explosion in a civilian bus. Ann Surg 209:484. https://doi.org/10.1097/00000658-198904000-00016
Kerr AG, Byrne JE (1975) Concussive effects of bomb blast on the ear. J Laryngol Otol 89:131–143. https://doi.org/10.1017/s002221510008018x
Miller ISM, McGahey D, Law K (2002) The otologic consequences of the Omagh bomb disaster. Otolaryngol - Head Neck Surg 126:127–128. https://doi.org/10.1067/mhn.2002.122186
Mrena R, Pääkkönen R, Bäck L et al (2004) Otologic consequences of blast exposure: a finnish case study of a shopping mail bomb explosion. Acta Otolaryngol 124:946–952. https://doi.org/10.1080/00016480310017045
Nawaz G, Ulhaq N, Khan AR (2014) Bomb blast injuries to the ear: the peshawar experience. J Med Sci 22:193–196
Pahor AL (1981) The ENT problems following the Birmingham bombings. J Laryngol Otol 95:399–406. https://doi.org/10.1017/s0022215100090873
Persaud R, Hajioff D, Wareing M, Chevretton E (2003) Otological trauma resulting from the Soho nail bomb in London, April 1999. Clin Otolaryngol Allied Sci 28:203–206. https://doi.org/10.1046/j.1365-2273.2003.00688.x
Radford P, Patel HDL, Hamilton N et al (2011) Tympanic membrane rupture in the survivors of the July 7, 2005, London bombings. Otolaryngol Head Neck Surg 145:806–812. https://doi.org/10.1177/0194599811411143
Remenschneider AK, Lookabaugh S, Aliphas A et al (2014) Otologic outcomes after blast injury: the Boston Marathon experience. Otol Neurotol 35:1825–1834. https://doi.org/10.1097/MAO.0000000000000616
Tucker K, Lettin A (1975) The tower of london bomb explosion. Br Med J 3:287–290. https://doi.org/10.1136/bmj.3.5978.287
Tungsinmunkong S, Chongkolwatana C, Piyawongvisal W et al (2007) Blast injury of the ears: the experience from Yala Hospital, Southern Thailand. J Med Assoc Thai 90:2662–2668
Van Haesendonck G, Van Rompaey V, Gilles A et al (2018) Otologic outcomes after blast injury: the brussels bombing experience. Otol Neurotol 39:1250–1255. https://doi.org/10.1097/MAO.0000000000002012
Walsh RM, Pracy JP, Huggon AM, Gleeson MJ (1995) Bomb blast injuries to the ear: the London bridge incident series. J Accid Emerg Med 12:194–198. https://doi.org/10.1136/emj.12.3.194
Sorlie T, Perou C, Tibshirani R et al (2001) National academy of sciences. Proc Natl Acad Sci USA 98:10869–10874. https://doi.org/10.1073/pnas.11175111
(2022) START (National Consortium for the Study of Terrorism and Responses to Terrorism). In: Glob. Terror. Database 1970–2020. https://www.start.umd.edu/gtd
Kronenberg J, Ben-Shoshan J, Wolf M (1993) Perforated tympanic membrane after blast injury. Am J Otol 14:92–94
Lou ZC, Lou ZH, Zhang QP (2012) Traumatic tympanic membrane perforations: a study of etiology and factors affecting outcome. Am J Otolaryngol Head Neck Med Surg 33:549–555. https://doi.org/10.1016/j.amjoto.2012.01.010
Tan HE, Santa Maria PL, Eikelboom RH et al (2016) Type I tympanoplasty meta-analysis: a single variable analysis. Otol Neurotol 37:838–846. https://doi.org/10.1097/MAO.0000000000001099
Acknowledgements
Thanks to Jennifer Manders, Lagojda Lukasz and Gavin Moore, who are clinical evidence-based information specialist librarians who designed and performed the literature search affiliated to the Queen Elizabeth Hospital library and University Hospitals Coventry and Warwickshire library.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No known competing financial interests or personal relationships which could appear to influence this paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Debenham, L., Khan, N., Nouhan, B. et al. A systematic review of otologic injuries sustained in civilian terrorist explosions. Eur Arch Otorhinolaryngol 281, 2223–2233 (2024). https://doi.org/10.1007/s00405-023-08393-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-023-08393-z