Transcript Case Studies from GWOT - Military Audiology Association

Case Studies from GWOT: This Isn’t Your
Grandfather’s NIHL
LtCol Angela Williamson
OIC, Audiology and Speech Clinic
Landstuhl Regional Medical Center, Germany
 Patients seen 48 - 72 hours post trauma
 In house for 3-7 days before departure to CONUS
 Average 20 flights/week from OEF/OIF
 3 Staff Audiologists, 1 Speech Pathologist
 BTE stock aids for immediate fitting
Case Studies from GWOT
 Cases drawn from one month period in Sept 07
 Patients asked to relate the events, if they could recall
them, whether HPD in place, location of blast related to
their body
 Complaints include:
 Ear pain
 Muffled hearing, “cotton in ears”
 Heightened sound sensitivity - hyperacusis
 Tinnitus
Hyperacusis
 Poorly understood, little research available
 Hyperacusis, Mechanisms, Diagnosis and Therapies
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By Baguley and Andersson, Plural Publishing
Noise trauma ~ Hyperacusis ~ Depression
PTSD
 Threat of death/seeing a death
 Fear reaction
 Hyper-arousal (sleep problems, irritability, concentration
problems, hyper-vigilance, exaggerated startle response)
Altered “gain” control in auditory system?
Research needed
Case 1
23 yr old, pre-deployment
KHz .25 .50 1K
+Hx OM
+Hx PE tubes 0
dB HL
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Case 1
23 yr old, after 1 IED blast
+Tinnitus
+Hearing Aid
KHz .25 .50 1K
0
dB HL
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Case 2
21 yr old, 1 RPG blast; RE TM perf
KHz .25 .50 1K
0
dB HL
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Case 3
28 yr old, 11B, pre-deployment
KHz .25 .50 1K
0
dB HL
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Case 3
28 yr old, 1 IED blast
KHz .25 .50 1K
dB HL
+Tinnitus, 18dBSL
0
+Hyperacusis
+Hearing aids
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Case 4
22 yr old, bullet to Lt Temp region
dB HL
KHz
mTBI
Gait disturbance
Type A, AU
0
+Tinnitus
?Ossic disartic 20
?Fx ossicle
40
60
80
100
.25 .50 1K
2K 3K 4K 6K 8K
x x x x x
x x x
>10 K
Case 5
36 yr old, 2 IED blasts, +CAE use
KHz .25 .50 1K
2K 3K 4K 6K 8K
0
dB HL
20
40
60
80
100
Pre- blast injury
Post- blast injury
>10 K
Case 5
36 yr old, 2 IED blasts, +CAE use
KHz .25 .50 1K
2K 3K 4K 6K 8K
0
dB HL
20
40
60
80
100
Pre- blast injury
Post- blast injury
>10 K
Case 6
46 yr old, 5 IED blasts, +CAE use
KHz .25 .50 1K
2K 3K 4K 6K 8K
0
dB HL
20
40
60
80
100
Pre- blast injury
Post- blast injury
>10 K
Case 6
46 yr old, 5 IED blasts, +CAE use
KHz .25 .50 1K
2K 3K 4K 6K 8K
0
dB HL
20
40
60
80
100
Pre- blast injury
Post- blast injury
>10 K
RPG at Forward Operating Base Guard Tower
Case 8
 Two patients seen in one
week from same blast
exposure
Case 7
 Case 8 described the
soldiers’ positions when
impact hit
 Exact angle of RPG unknown
 Neither had HPD at time of
attack
Case 7
20 yr old, 1 RPG attack
Lt TM perf
Lt T-plasty, 12-07
KHz .25 .50 1K
0
dB HL
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Case 8
24 yr old, 1 RPG attack
Bilat TM perf
+Hearing aids
mTBI
+Tinnitus
KHz .25 .50 1K
0
dB HL
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Case 9
31 yr old, 1 IED blast to left
dB HL
NATO officer
KHz .25 .50 1K
Severe tinnitus
RE TM retracted 0
to -200mm
LE Type A
20
40
60
80
100
2K 3K 4K 6K 8K
>10 K
Conclusion
 Ruptured TM
 High risk for cholesteatoma, need f/u for years
 Ask about hyperacusis, document it
 Talk about tinnitus, document it
 Consider use of Tinnitus Handicap Inventory
 Tinnitus match
 Talk about CAE - They work!
 Talk about APD, screen for it
 Dichotic digits
 HINT
 SSI-ICM
 [email protected]
 [email protected]