The Implications of Physical Injury on Otovestibular and Cognitive Symptomatology following Blast Exposure

Abstract

Objectives:

Identify a potential difference in the spectrum of otovestibular and cognitive symptoms in blast-exposed patients either with or without significant extremity injuries.

Methods:

A retrospective chart review of 100 consecutive blast-exposed patients seen in the otolaryngology department vestibular clinic at a military tertiary care medical center in 2011 was performed. New patient encounters were identified in the electronic medical record, and all patients referred for otovestibular evaluation after a blast injury or exposure were included. A convenience sample of 100 consecutive patients meeting the criteria was studied. Data including presence of extremity injuries, diagnosis of mild traumatic brain injury, symptoms of imbalance, vertigo, headache, tympanic membrane perforation, hearing loss, tinnitus, insomnia, and memory loss were collected and analyzed.

Results:

Of 100 patients included, 38 suffered severe extremity injuries. Those patients with severe extremity injuries were more likely to suffer from tympanic membrane perforations (58% vs. 23%, P = 0.0004) and hearing loss (53% vs. 23%, P = 0.002), less likely to suffer from imbalance (32% vs. 79%, P = 0.000002) and vertigo (2% vs. 47%, P = 0.000003), and less likely to have been diagnosed with a mild traumatic brain injury (26% vs. 66%, P = 0.0001).

Conclusions:

Blast-exposed individuals who sustained severe extremity injuries reported significantly fewer cognitive and vestibular symptoms. In the aftermath of a blast, those who can walk away may have still sustained a significant injury. Specifically, they may suffer more long-term cognitive and vestibular symptoms than those with severe physical injuries.