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Case Studies from GWOT: This Isn’t Your Grandfather’s NIHL

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

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Case Studies from GWOT: This Isn’t Your Grandfather’s NIHL

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  1. Case Studies from GWOT: This Isn’t Your Grandfather’s NIHL LtCol Angela Williamson OIC, Audiology and Speech Clinic Landstuhl Regional Medical Center, Germany

  2. 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

  3. 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

  4. Hyperacusis • Poorly understood, little research available • Hyperacusis, Mechanisms, Diagnosis and Therapies 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

  5. Case 123 yr old, pre-deployment KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K +Hx OM +Hx PE tubes 0 20 dB HL 40 60 80 100

  6. Case 123 yr old, after 1 IED blast +Tinnitus +Hearing Aid KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 100

  7. Case 221 yr old, 1 RPG blast; RE TM perf KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 100

  8. Case 328 yr old, 11B, pre-deployment KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 100

  9. Case 328 yr old, 1 IED blast KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K +Tinnitus, 18dBSL +Hyperacusis +Hearing aids 0 20 dB HL 40 60 80 100

  10. Case 422 yr old, bullet to Lt Temp region KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K mTBI Gait disturbance Type A, AU +Tinnitus ?Ossic disartic ?Fx ossicle 0 20 x x x x x x x x dB HL 40 60 80 100

  11. Case 536 yr old, 2 IED blasts, +CAE use KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 Pre- blast injury Post- blast injury 100

  12. Case 536 yr old, 2 IED blasts, +CAE use KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 Pre- blast injury Post- blast injury 100

  13. Case 646 yr old, 5 IED blasts, +CAE use KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 Pre- blast injury Post- blast injury 100

  14. Case 646 yr old, 5 IED blasts, +CAE use KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 Pre- blast injury Post- blast injury 100

  15. RPG at Forward Operating Base Guard Tower Case 8 • Two patients seen in one week from same blast exposure • Case 8 described the soldiers’ positions when impact hit • Exact angle of RPG unknown • Neither had HPD at time of attack Case 7

  16. Case 720 yr old, 1 RPG attack KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K Lt TM perf Lt T-plasty, 12-07 0 20 dB HL 40 60 80 100

  17. Case 824 yr old, 1 RPG attack KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K Bilat TM perf +Hearing aids mTBI +Tinnitus 0 20 dB HL 40 60 80 100

  18. Case 931 yr old, 1 IED blast to left NATO officer Severe tinnitus RE TM retracted to -200mm LE Type A KHz .25 .50 1K 2K 3K 4K 6K 8K >10 K 0 20 dB HL 40 60 80 100

  19. 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 • Angela.Williamson@amedd.army.mil • Angela.Williamson@us.af.mil

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