Study shows continued follow up and care of this patient population is warranted.
After two bombs exploded near the finish line of the Boston Marathon on April 15, 2013, acute trauma to the ears – such as ruptured eardrums – was immediately apparent to those caring for the victims. However, the full extent of the effect on the ears and hearing of victims was not fully recognized for weeks. In the end, more than 100 patients were evaluated for blast-related otologic injuries.
Almost immediately, Boston researchers set out to detail the types of otologic injury and report on the outcomes of patients undergoing otologic treatment. Ninety-four of the injured individuals elected to enroll in an eight-institution study that began before the end of April 2013 through the efforts of Harvard Catalyst, the clinical and translational science center that facilitated a framework for Harvard Medical School-affiliated institutions to speed the review of human studies. The research findings will be reported in the December 2014 issue of the journal Otology & Neurotology and are available online now.
“The purpose of this report is describe the burden of otologic injury following the Boston Marathon Bombings and to understand how otologic trauma has affected patients’ quality of life,” said lead author Aaron Kyle Remenschneider, M.D., physician-researcher affiliated with Massachusetts Eye and Ear and Harvard Medical School, who was Mass. Eye and Ear’s chief resident at the time of the bombings and cared for many of the victims.
Using a multi-institutional, prospective cohort study, researchers from eight medical campuses evaluated children and adults seen for otologic complaints related to the Boston Marathon bombings. Participants completed an otologic/noise exposure history, a current symptom assessment and quality of life questionnaires at initial visits and six months later. Records from otologic evaluation and audiometry were reviewed.
“Of the 94 patients that enrolled, only 7 percent had any otologic symptoms prior to the blasts,” said Alicia Quesnel, M.D., senior author and otologic surgeon at Mass. Eye and Ear and Harvard Medical School, who continues to provide care for these patients. “All patients evaluated reported hearing loss or tinnitus.”
Seventy-nine patients had initial audiograms available for review that revealed conductive, sensorineural or mixed hearing losses. Ninety percent of hospitalized patients suffered ruptured eardrums. Those who were closest to the blasts and who had other significant injuries also experienced ruptured eardrums. Twenty-one non-healing ear drum perforations were surgically repaired with closure of the perforation in all but two.
“Hearing, tinnitus and dizziness-related quality of life was found to be impaired in these patients,” Dr. Quesnel continued. “Our conclusion is that blast-related ear injuries constitute a major source of ongoing morbidity following the bombings. Patient symptoms continue to evolve and many patients have ‘hidden hearing loss,’ which may not be apparent on routine hearing tests. There is a definite need for long-term follow-up assessments to ensure that patients receive appropriate testing and treatment.”
The need for ongoing care for hearing-related issues was acknowledged in September 2014 when One Fund Boston, the charity created to accept and distribute donations to help those affected by the bombings, created the One Fund Center, which will serve patients who have had difficulties with tinnitus and other hearing-related problems; mental health issues, including post-traumatic stress disorder and anxiety; and traumatic brain injury and its associated symptoms such as headache, cognitive symptoms and balance difficulties. Hearing loss and tinnitus care, which will be coordinated through Mass. Eye and Ear, will involve a combination of medical evaluation, state-of-the-art hearing testing, pharmacologic intervention, acupuncture and stress management techniques.
In addition to Drs. Remenschneider and Quesnel, authors include Sarah Lookabaugh, M.D., (Mass. Eye and Ear), Avner Aliphas, M.D. (Boston Medical Center), Jacob Brodsky, M.D., (Boston Children’s Hospital), Anand Devaiah, M.D. (Boston Medical Center), Kenneth Grundfast, M.D., (Boston Medical Center), Selena Heman-Ackah, M.D. (Beth Israel Deaconess Medical Center), Samuel Robin, B.A. (Boston Medical Center), Jonathan Sillman, M.D. (Tufts Medical Center), Angela Tsai, M.D. (Boston Medical Center), Sharon Kujawa, Ph.D. (Mass. Eye and Ear) and Daniel Lee, M.D. (Mass. Eye and Ear, Brigham and Women’s Hospital).