Assessment of hearing loss induced by tympanic membrane perforations under blast environment

  • Pengpeng Xie
  • Yong PengEmail author
  • Junjiao Hu
  • Anquan Peng
  • Shengen Yi



This study provides an approach to estimating tympanic membrane perforation-induced hearing loss (HL) using a human middle ear model.


Sixty-one cases of tympanic membrane perforation originating from fireworks were reported from the Ear–Nose–Throat Department. The otoscope, audiometry data and diagnosis records were organized, and gender, age, etiology, perforation size and diseased ear side were classified as independent variables. A multinomial regression model was used to analyze the potential effects of the variables on HL. Meanwhile, a human middle ear model was implemented to calculate the ensued HL resulting from different perforation areas and sites. In addition, linear regression models were used to establish functions between perforation size and HL.


The audiometry data indicate that HL at high frequencies (f > 2 kHz) is much more profound than that at the speech frequency band (f < 1 kHz). Compared with mild HL (<15 dB), mediate HL (15–30 dB) was correlated with the perforation area (p < 0.05, 95% CI), while severe HL (>30 dB) was affected by both perforation size and age (p < 0.05, 95% CI). However, other factors, including gender and diseased ear side, do not show a statistically significant effect on HL. Furthermore, the Kruskal–Wallis test result reveals that HL at frequencies of 0.25 kHz ≤ f ≤ 8 kHz is strongly associated with the perforation size (p < 0.05, 95% CI).


It is conclusive that HL is positively proportional to the perforation size. However, HL is not correlated with the perforation site for small perforation areas of < 10% (p > 0.05, 95% CI).


Blast wave environment Tympanic membrane Perforation size Hearing loss Human ear model 



This work presented in the article is supported by the National Natural Science Foundation of China (Grant No. 51405517), China Postdoctoral Science Foundation (Grant No. 2015M570691), the Hu-Xiang Youth Talent Program (No. 2018RS3002) and the Innovation-Driven Project of Central South University (No. 2018CX021).

Compliance with ethical standards

Conflicts of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the ICH-GCP, “China GCP” and related regulation and law of China. This article does not contain any studies animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Sakata T, Esaki Y, Yamano T, Sueta N, Nakagawa T, Kato T (2009) Air pressure-sensing ability of the middle ear—investigation of sensing regions and appropriate measurement conditions. Auris Nasus Larynx 36(4):393–399CrossRefGoogle Scholar
  2. 2.
    Lou ZC, Tang YM, Yang J (2011) A prospective study evaluating spontaneous healing of aetiology, size and type-different groups of traumatic tympanic membrane perforation. Clin Otolaryngol 36(5):450–460CrossRefGoogle Scholar
  3. 3.
    Qureshi TA, Awan MS, Hassan NH, Aftab AH, Ali SA (2017) Effects of bomb blast injury on the ears: The Aga Khan University Hospital experience. J Pak Med Assoc 67(9):1313PubMedGoogle Scholar
  4. 4.
    Mrena R, Paakkonen R, Back L, Pirvola U, Ylikoski J (2004) Otologic consequences of blast exposure: a finnish case study of a shopping mall bomb explosion. Acta Otolaryngol 124(8):946–952CrossRefGoogle Scholar
  5. 5.
    Becker GD, Parell GJ (2001) Barotrauma of the ears and sinuses after scuba diving. Eur Arch Oto-Rhino-L 258(4):159–163CrossRefGoogle Scholar
  6. 6.
    Dahiya R, Keller JD, Litofsky NS, Bankey P, Bonassar LJ, Megerian CA (1999) Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations. J Trauma Acute Care 47(6):1079CrossRefGoogle Scholar
  7. 7.
    Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E, Can N (2011) Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. Eur Arch Oto-Rhino-L 268(3):471–474CrossRefGoogle Scholar
  8. 8.
    Patterson JH Jr, Hamernik RP (1997) Blast overpressure induced structural and functional changes in the auditory system. Toxicology 121:29–40CrossRefGoogle Scholar
  9. 9.
    Deguine C, Pulec JL (1995) Traumatic dislocation of the incus. ENT Ear Nose Throat 74:800CrossRefGoogle Scholar
  10. 10.
    Lemonick DM (2011) Bombings and blast injuries: a primer for physicians. Am J Clin Med 8(3):134–140Google Scholar
  11. 11.
    Matsuda Y, Kurita T, Ueda Y, Ito S, Nakashima T (2009) Effect of tympanic membrane perforation on middle-ear sound transmission. J Laryngol Otol 123(S31):81–89CrossRefGoogle Scholar
  12. 12.
    Littlefield PD, Brungart DS (2019) Long-term sensorineural hearing loss in patients with blast-induced tympanic membrane perforations. Ear Hearing. CrossRefGoogle Scholar
  13. 13.
    Ahmad SW, Ramani GV (1979) Hearing loss in perforations of the tympanic membrane. J Laryngol Otol 93(11):1091–1098CrossRefGoogle Scholar
  14. 14.
    Berger G, Finkelstein Y, Avraham S, Himmelfarb M (1997) Patterns of hearing loss in non-explosive blast injury of the ear. J Laryngol Otol 111(12):1137–1141CrossRefGoogle Scholar
  15. 15.
    Griffin WL Jr (1979) A retrospective study of traumatic tympanic membrane perforations in a clinical practice. Laryngoscope 89(2):261–282CrossRefGoogle Scholar
  16. 16.
    Voss SE, Rosowski JJ, Merchant SN, Peake WT (2001) Middle-ear function with tympanic membrane perforations: I – measurements and mechanisms. J Acoust Soc Am 110:1432–1444CrossRefGoogle Scholar
  17. 17.
    Voss SE, Rosowski JJ, Merchant SN, Peake WT (2001) Middle-ear function with tympanic-membrane perforations. II. A simple model. J Acoust Soc Am 110(3):1445–1452CrossRefGoogle Scholar
  18. 18.
    Voss SE, Rosowski JJ, Merchant SN, Peake WT (2001) Measurements and mechanisms of middle-ear function with tympanic membrane perforations. J Acoust Soc Am 110:1432–1444CrossRefGoogle Scholar
  19. 19.
    Wada H, Koike T, Matsutani S, Kobayashi T, Takasaka T (1997) Dynamic behavior of middle ear with tympanic membrane perforation. Audiology (Japan) 40(1):46–51Google Scholar
  20. 20.
    Xie PP, Peng Y, Hu JJ, Yi SG (2019) A study on the effect of ligament and tendon detachment on human middle ear sound transfer using mathematic model. Proc IMechE Part H J Eng Med 00:1–9Google Scholar
  21. 21.
    Xie PP, Peng Y, Wang TT, Zhang HH (2019) Risks of ear complaints of passengers and drivers while trains are passing through tunnels at high speed: a numerical simulation and experimental study. Int J Env Res Publ Health 16(7):1283CrossRefGoogle Scholar
  22. 22.
    Kim H, Lee JJ, Moon Y, Park HY (2019) Longitudinal pure-tone threshold changes in the same subjects: analysis of factors affecting hearing. Laryngoscope 129(2):470–476CrossRefGoogle Scholar
  23. 23.
    Zhang HH, Peng Y, Hou L, Tian G, Li Z (2019) A hybrid multi-objective optimization approach for energy-absorbing structures in train collisions. Inform Sci 481:491–506CrossRefGoogle Scholar
  24. 24.
    Schwaber MK (2003) Trauma to the middle ear, inner ear, and temporal bone. Ballenger's Otorhinolaryngol Head Neck Surg 14:345–356Google Scholar
  25. 25.
    Shah A, Ayala M, Capra G, Shah A, Ayala M, Capra G, Fox D, Hoffer M (2014) Otologic assessment of blast and nonblast injury in returning middle east-deployed service members. Laryngoscope 124(1):272–277CrossRefGoogle Scholar
  26. 26.
    Jellinge ME, Kristensen S, Larsen K (2015) Spontaneous closure of traumatic tympanic membrane perforations: observational study. J Laryngol Otol 129(10):950–954CrossRefGoogle Scholar
  27. 27.
    Sridhara SK, Rivera A, Littlefield P (2013) Tympanoplasty for blast-induced perforations: the walter reed experience. Otolaryng Head Neck 148(1):103–107CrossRefGoogle Scholar
  28. 28.
    Rehman A, Nawaz G, Khan AR (2015) Traumatic perforation of tympanic membrane. J Med Sci 23(4):184–186Google Scholar
  29. 29.
    Ediale J, Adobamen PROC, Ibekwe TS (2017) Aetiological factors and dimension of tympanic membrane perforation in Benin City, Nigeria. P H Med J 11(2):55Google Scholar
  30. 30.
    Limongi F, Noale M, Siviero P, Crepaldi G, Maggi S (2015) Epidemiology of aging, dementia and age-related hearing loss. Hear Balance Commun 13(3):95–99CrossRefGoogle Scholar
  31. 31.
    Quaranta N, Coppola F, Casulli M, Barulli O, Lanza F, Tortelli R, Capozzo R, Leo A, Tursi M, Grasso A, Solfrizzi V, Sobbà C, Logroscino G (2014) The prevalence of peripheral and central hearing impairment and its relation to cognition in older adults. Audiol Neuro-Otol 19(Suppl. 1):10–14CrossRefGoogle Scholar
  32. 32.
    Peng Y, Fan C, Hu L, Peng SL, Xie PP, Wu F, Yi SG (2019) Tunnel driving occupational environment and hearing loss in train drivers in China. Occup Environ Med 76(2):97–104CrossRefGoogle Scholar
  33. 33.
    Wang YW, Zhang LT, Zhang JH, Zhang XQ, Zhang WM, Chen X, Tang SX (2016) The clinical analysis of bilateral successive sudden sensorineural hearing loss. Eur Arch Oto-Rhino-L 273(11):3679–3684CrossRefGoogle Scholar
  34. 34.
    de Régloix SB, Crambert A, Maurin O, Lisan Q, Marty S, Pons Y (2017) Blast injury of the ear by massive explosion: a review of 41 cases. J R Army Med Corps 163(5):333–338CrossRefGoogle Scholar
  35. 35.
    Chongkolwatana C, Atipas S, Metheetrairut C (2017) Blast injury of the ears. Siriraj Med J 61(4):228–229Google Scholar
  36. 36.
    Dessai TD, Philip R (2017) Influence of tympanic membrane perforation on hearing loss. Global J Otolaryngol 5(5):1–4CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Key Laboratory of Traffic Safety On Track, Ministry of Education, School of Traffic and Transportation EngineeringCentral South UniversityChangshaChina
  2. 2.Joint International Research Laboratory of Key Technology for Rail Traffic SafetyCentral South UniversityChangshaChina
  3. 3.National and Local Joint Engineering Research Center of Safety Technology for Rail VehicleCentral South UniversityChangshaChina
  4. 4.Department of of RadiologyThe Second Xiangya HospitalCentral South UniversityChangshaChina
  5. 5.Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya HospitalCentral South UniversityChangshaChina
  6. 6.Research Laboratory of Hepatobiliary Diseases General Surgical Department, The Second Xiangya HospitalCentral South UniversityChangshaChina

Personalised recommendations