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Case Studies from GWOT: This Isn’t Your Grandfather’s NIHL
LtCol Angela WilliamsonLtCol Angela Williamson
OIC, Audiology and Speech ClinicOIC, Audiology and Speech Clinic
Landstuhl Regional Medical Center, GermanyLandstuhl Regional Medical Center, Germany
Patients seen 48 - 72 hours post traumaPatients seen 48 - 72 hours post trauma In house for 3-7 days before departure to CONUSIn house for 3-7 days before departure to CONUS Average 20 flights/week from OEF/OIFAverage 20 flights/week from OEF/OIF 3 Staff Audiologists, 1 Speech Pathologist3 Staff Audiologists, 1 Speech Pathologist BTE stock aids for immediate fittingBTE stock aids for immediate fitting
Case Studies from GWOT
Cases drawn from one month period in Sept 07Cases drawn from one month period in Sept 07 Patients asked to relate the events, if they could recall Patients asked to relate the events, if they could recall
them, whether HPD in place, location of blast related to them, whether HPD in place, location of blast related to their bodytheir body
Complaints include:Complaints include: Ear painEar pain Muffled hearing, “cotton in ears”Muffled hearing, “cotton in ears” Heightened sound sensitivity - hyperacusisHeightened sound sensitivity - hyperacusis TinnitusTinnitus
Hyperacusis
Poorly understood, little research availablePoorly understood, little research available Hyperacusis, Mechanisms, Diagnosis and TherapiesHyperacusis, Mechanisms, Diagnosis and Therapies
By Baguley and Andersson, Plural PublishingBy Baguley and Andersson, Plural Publishing Noise trauma ~ Hyperacusis ~ DepressionNoise trauma ~ Hyperacusis ~ Depression PTSD PTSD
Threat of death/seeing a deathThreat of death/seeing a death Fear reactionFear reaction Hyper-arousal (sleep problems, irritability, concentration Hyper-arousal (sleep problems, irritability, concentration
problems, hyper-vigilance, exaggerated startle response)problems, hyper-vigilance, exaggerated startle response) Altered “gain” control in auditory system?Altered “gain” control in auditory system? Research neededResearch needed
Case 123 yr old, pre-deployment
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 K
+Hx OM+Hx PE tubes
Case 123 yr old, after 1 IED blast
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 K+Tinnitus
+Hearing Aid
Case 221 yr old, 1 RPG blast; RE TM perf
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 K
Case 328 yr old, 11B, pre-deployment
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 K
Case 328 yr old, 1 IED blast
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 K
+Tinnitus, 18dBSL+Hyperacusis+Hearing aids
Case 422 yr old, bullet to Lt Temp region
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 K
x xx x x
x xx
mTBIGait disturbanceType A, AU+Tinnitus?Ossic disartic?Fx ossicle
Case 536 yr old, 2 IED blasts, +CAE use
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz
Pre- blast injuryPost- blast injury
>10 K
Case 536 yr old, 2 IED blasts, +CAE use
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz
Pre- blast injuryPost- blast injury
>10 K
Case 646 yr old, 5 IED blasts, +CAE use
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz
Pre- blast injuryPost- blast injury
>10 K
Case 646 yr old, 5 IED blasts, +CAE use
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz
Pre- blast injuryPost- blast injury
>10 K
RPG at Forward Operating Base Guard Tower
Two patients seen in one Two patients seen in one week from same blast week from same blast exposureexposure
Case 8 described the Case 8 described the soldiers’ positions when soldiers’ positions when impact hitimpact hit
Exact angle of RPG unknownExact angle of RPG unknown Neither had HPD at time of Neither had HPD at time of
attackattack
Case 7
Case 8
Case 720 yr old, 1 RPG attack
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 K
Lt TM perfLt T-plasty, 12-07
Case 824 yr old, 1 RPG attack
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 KBilat TM perf
+Hearing aidsmTBI+Tinnitus
Case 931 yr old, 1 IED blast to left
20
40
60
80
100
0
.25 .50 1K 2K 3K 4K 6K 8Kd
B H
LKHz >10 KNATO officer
Severe tinnitusRE TM retracted to -200mmLE Type A
Conclusion
Ruptured TM Ruptured TM High risk for cholesteatoma, need f/u for yearsHigh risk for cholesteatoma, need f/u for years
Ask about hyperacusis, document itAsk about hyperacusis, document it Talk about tinnitus, document itTalk about tinnitus, document it
Consider use of Tinnitus Handicap InventoryConsider use of Tinnitus Handicap Inventory Tinnitus matchTinnitus match
Talk about CAE - They work!Talk about CAE - They work! Talk about APD, screen for itTalk about APD, screen for it
Dichotic digitsDichotic digits HINTHINT SSI-ICMSSI-ICM
[email protected]@amedd.army.mil [email protected]@us.af.mil
