Initially preoccupied by the severe injuries sustained by victims of the Boston bombings, hospitals are now grappling with a more subtle medical consequence: widespread hearing loss among those closest to the blasts.
Acoustic trauma of this sort can rupture the delicate eardrum, and hearing experts at several hospitals in Boston said on Wednesday that torn eardrums accounted for most of the hearing loss they have seen among those near the explosions.
In most of these cases, the eardrum will heal in a few weeks or months. If not, a tear can be repaired with an outpatient surgical reconstruction called a tympanoplasty, which can restore normal hearing.
But proximity to an explosion also can cause “sensorineural” hearing loss: damage to hair cells in the inner ear, which is potentially permanent, said Dr. Daniel Lee, an ear surgeon at Brigham and Women’s Hospital in Boston. Hair cells cannot be regenerated.
“We’re generally seeing patients who have a conductive hearing loss associated with traumatic eardrum perforation,” he said. “Some of the patients may develop a progressive sensorineural hearing loss in the future.”
At present, most of the patients with sensorineural damage have suffered only mild to moderate hearing loss. There is great variability in the hearing loss experienced by people exposed to acoustic trauma, based on things like which way they were facing or what was between them and the explosion.
Nick Yanni, 32, a student at Bunker Hill Community College, and his wife, Lee Ann Yanni, 31, a physical therapist, were 10 feet from the first bomb when it went off. Ms. Yanni said she immediately lost hearing in her left ear, but at the time was far more worried about her broken left fibula.
At the emergency room at Tufts Medical Center, she struggled to answer doctors’ muffled questions about her leg.
Mr. Yanni discovered at the E.R. that he could not hear in either ear and tried to read lips. An hour or two later, his ears became painfully sensitive to background noise, so he put in earplugs. By nightfall, his hearing had returned.
“We were standing right next to each other,” Ms. Yanni said. “His hearing loss turned out to be temporary, and mine is lasting.”
After three operations for her leg fracture in five days, she was discharged on Monday. “I know I can function even if my hearing isn’t perfect, but I’d like to get it back,” Ms. Yanni said.
Within 24 hours of the bombings, Beth Israel Deaconess Medical Center in Boston began auditory evaluations of bombing victims after several mentioned that voices sounded as if they were underwater or that their own voices seemed louder.
Dr. Selena E. Heman-Ackah, medical director of otology, neurotology and audiology at Beth Israel Deaconess, has evaluated roughly 20 patients with hearing loss in wake of bombings. All but two suffered perforations of the eardrums, she said.
Given the loudness of the explosions, Dr. Heman-Ackah said she expected to see more patients with nerve-related hearing loss. She believes that the eardrum perforations might have been protective against the more permanent neural loss.
The night of the bombings, Dr. Alicia M. Quesnel, an ear specialist at the Massachusetts Eye and Ear Infirmary, began doing consultations with some patients injured by bomb blasts, once they had been stabilized, using a tuning fork to gauge the type of auditory loss.
If patients can hear the tuning fork touching their skull, the hearing loss is probably conductive — related to a torn eardrum or damage to the tiny bones behind it. But if they can hear a tuning fork held in front of the ear better, or cannot hear either one, Dr. Quesnel said, “you worry about inner ear hearing loss that’s neural.”
“Most of what we are seeing is conductive hearing loss,” she said. “It will either heal on its own, or down the line they won’t end up with a huge hearing loss because it can be fixed.”
Dr. Jonathon Sillman, an ear specialist at Tufts Medical Center, has evaluated about 10 bombing victims for hearing injuries. All were given audiograms as soon as they could sit in a wheelchair in a soundproof booth.
“One of the most striking things about this experience is how variable the injuries were,” Dr. Sillman said. One patient was standing next to a person who lost her legs, he said, yet “her only injury is one perforated eardrum with no neural hearing loss.” He suspects the person who lost her limbs must have shielded his patient from the energy of the blast.
Like nearly everyone in the country, our attention and thoughts were with the cities of Boston and West, Texas last week as they dealt with the marathon bombing and fertilizer plant tragedies. At last count, nearly 264 injuries and three deaths have been reported in Boston, while 14 died and more than 200 were injured in Texas. These numbers have risen over the past few days with many of these injuries being hearing-related.
We talked to Harvey Abrams, Director of Audiology Research with Starkey Hearing Technologies, about some of these hearing injuries. Before working for Starkey Hearing Technologies, Abrams spent 35 years working for the V.A., helping veterans with hearing damage. Abrams noted that many of the injuries he is learning about are similar to those associated with blast injuries he saw in Iraq and Afghanistan.
“The effects from the blast are very unpredictable because the extent and type of auditory damage depend on the size of the explosion, the distance the victim is from the blast, the direction the victim is facing relative to the blast, the use of protective gear, and the immediate environment (surrounding objects such as buildings, walls, vehicles, etc.),” said Abrams.
“Some damage will likely occur to inner ear structures (hair cells) resulting in temporary or permanent sensorineural hearing loss of varying degrees but most likely affecting the high frequencies.”
Abrams said that the symptoms of blast-induced hearing loss vary.
“Immediate symptoms of ear drum perforation and middle ear damage include pain, bleeding from ears, tinnitus, hearing loss and feeling of fullness in the ears,” he said.
”Blast-induced hearing loss without ear drum perforation is often associated with tinnitus, muffled sounds, difficulty understanding speech and change in the quality of environmental sounds. This hearing loss can be temporary, lasting hours to days but can also be permanent in some cases.”
Boston’s MPR station, 90.9 WBUR spoke with Dr. Alicia Quesnel, an ear specialist, who treated more than a dozen marathon bombing victims with hearing-related injuries. “Most of the injuries that I’ve seen have been problems with hearing loss and then problems with ruptured ear drums or holes in the ear drums that have been created literally from the blast traumas,” said Dr. Quesnel.
”And there have been a lot of patients who, unfortunately, are missing parts of the ear drums or there are large tears in the ear drums. That’s mostly what we’ve been seeing, and they have hearing loss as a result of that.”
You can read the entire interview with Dr. Quesnel here.