Eardrum perforation in explosion survivors: Is it a marker of pulmonary blast injury?

Study objectives: To determine whether isolated eardrum perforation is a ma rker for concealed blast lung injury in survivors of terrorist bombings. Methods: Survivors who arrived at hospitals after 11 terrorist bombings in Israel between April 6, 1994, and March 4, 1996, were examined otoscopicall y by ear, nose, and throat specialists. All patients with eardrum perforati on underwent chest radiography and were hospitalized for at least 24 hours for observation. The clinical course and final outcome of patients with iso lated perforation of the eardrums and of those with other blast injuries we re surveyed. Results: A total of 647 survivors were examined; 193 (29.8%) of them sustai ned primary blast injuries, including 142 with isolated eardrum perforation and 51 with other forms of blast injuries (18 with isolated pulmonary blas t injury, 31 with combined otic and pulmonary injuries, and 2 with intestin al blast injury). Blast lung injury was promptly diagnosed on admission by physical examination and chest radiography. No patient presenting with isol ated eardrum perforation developed later signs of pulmonary or intestinal b last injury (mean 0%; 95% confidence interval, 0% to 2.7%). Conclusion: Isolated eardrum perforation in survivors of explosions does no t appear to be a marker of concealed pulmonary blast injury nor of a poor p rognosis. Therefore, in a mass casualty event, persons who have sustained i solated eardrum perforation from explosions may safely be discharged from t he emergency department after chest radiography and a brief observation per iod.