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  • Title: Tympanoplasty for blast-induced perforations: the Walter Reed experience.
    Author: Sridhara SK, Rivera A, Littlefield P.
    Journal: Otolaryngol Head Neck Surg; 2013 Jan; 148(1):103-7. PubMed ID: 22951430.
    Abstract:
    OBJECTIVE: To review our tympanoplasty results for blast-induced tympanic membrane perforations and evaluate the association of various clinical factors with surgical success. STUDY DESIGN: Case series with chart review. SETTING: Two tertiary military healthcare institutions. METHODS: This is a retrospective review of all patients who had nonrevision tympanoplasty during a 1-year period for blast-induced perforations by the 2 neurotologists at Walter Reed Army Medical Center and National Naval Medical Center. Various perioperative clinical factors were analyzed for relations to successful perforation closure, the need for a second operation, and postoperative hearing. RESULTS: Thirty-four patients met inclusion criteria. All were male, and the average age was 24.0 years. Twenty-two (65%) were total or near-total perforations, of which 12 (35%) were repaired using lateral graft technique. The remainder had various medial graft procedures. Ossicular abnormalities were found in 6 (18%) patients. Cholesteatoma was discovered in 3 (9%) patients. Closure was complete in 82% of patients. The incomplete closures were with large perforations, those with foreign bodies (shrapnel), and in 1 with postoperative water exposure. There were no major complications, and the mean conductive hearing improvement was 11.3 dB. CONCLUSION: Blast-induced tympanic membrane perforations are common in our population of wounded warriors. These cases are challenging because most have total or near-total perforations, the ossicles can be out of place, the blast itself can implant epithelium in the middle ear, and foreign bodies can create a hostile middle ear environment. However, given attention to detail, we found that standard tympanoplasty techniques work well.
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