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Brooke Thall Dr. Riley Foundations of College Writing May 8, 2013 Hearing Loss from Explosions After a bombing or explosion a person’s hearing is never priority. There is usually many other severe even life threatening wounds that take precedence. However, after the initial panic and once things begin to settle down and a full health checkup takes place, doctors will many times discover that their patient has hearing loss. The hearing loss may be temporary or permanent but either way it can have a huge effect on the person’s life. Hearing loss is one of the most common and also one of the least focused on injuries that often effect bomb victims. After a bombing when a patient goes to receive medical care, the doctor’s first priority is usually any life threatening injuries that have occurred. Once the patient is in a more stable condition they move on to a more overall checkup. It is usually during this process that they realize that the person has hearing loss. There are many different signs that the patient has acquired hearing loss. The person can outright lose hearing in one or both of his or hers ears, or all noises may just seem muffled to the person. Also his or hers ears may become very sensitive to back ground noises. Hearing loss can be very evident in a patient. Many times they cannot understand the questions you are trying to ask them. Hearing loss can usually be easily identified after a bombing. The patient may feel like his ears are clogged, that everything is muffled, or may have a ringing in his ears. Also his ears will be very sensitive and any kind of noise may hurt his ears. The patient may be talking very loudly because he cannot tell what volume they are speaking at. If he doesn’t have these obvious signs of hearing loss an audiologist may still do a hearing test on him. Hearing loss can affect people in many different ways depending on what type of hearing loss and how severe it is. When people are near to an explosion such as with the bombing at the Boston Marathon hospitals often find that many of the people that were closest to the explosion are now dealing with hearing loss. The two more common forms of hearing loss that the victims are dealing with are acoustic trauma that causes conductive hearing loss Figure 1 source: American Tinnitus Association 2008 and sensorineural hearing loss. With the acoustic trauma the delicate ear drum may rupture. With only acoustic trauma the eardrum will most likely heal within a few weeks or months. However, if the eardrum does not repair itself the torn can be repaired with an outpatient surgical reconstruction called a tympanoplasy. (Louis) Conductive and sensory hearing loss have very different effects on the patient. The ear is a very complex and sensitive system. The auricle, external auditory canal, tympanic membrane, and ossicular chain all work together to localize, amplify, and transmit sound to the cochlea. Usually a person with sensorineural hearing loss has a genetic deposition to it while a person with a conductive hearing loss usually has some kind of infection or acoustic trauma to the ear drum. Many soldiers who come back from war have some form of hearing loss. Hearing loss is in veterans is one of the most prevalent disabilities. As seen in Figure 1 ear plugs are recommended for volumes 85 decibels or above, yet tanks, Chinook helicopters and grenades have higher decibels than that. Saunders and Griest (2009) from the National Center for Rehabilitative Auditory Research state that, ” There are currently 444,583 veterans receiving compensation for defective hearing and 395,324 receiving compensation for tinnitus. [4] It is estimated that there are almost one million more veterans with service-connected hearing loss and/or tinnitus who do not meet the criteria for receiving compensation. The cost of compensation for hearing and tinnitus-related disabilities in fiscal year (FY) 2006 was over USD 1.2 billion.” Hearing loss in soldiers is caused by combat and working in industrial places such as ship building yards and aircraft maintenance. Dr. Henry Lew conducted a study of a group of 66 Iraq War soldier. Thirty eight of these soldiers were injured and treated and Figure 2Source The Hearing Journal 2009 after 2 years of recovery the most common long term symptom that the soldiers had was hearing loss. (Tun, Hogan, Fitzharris 2009) As shown in figure 2 tympanic membrane, cochlear or vestibular rupture is one of the primary injuries for soldiers. Hearing loss is a very troubling injury and can be very unpredictable. There are some treatments for it though none are proven. As stated by Benjamin E Schreiber, MRCPa, Charlotte Agrup, PhDb, Prof Dorian O Haskard, FMedScic, and Prof Linda M Luxon, FRCPd (2010), “Many treatments are used, including corticosteroids, antiviral drugs, and vasoactive and oxygen-based treatments. Although no treatment is proven, we recommend a short course of oral high-dose corticosteroids. There is much to learn about pathogenesis of sudden sensorineural hearing loss, and more clinical trials are needed to establish evidence-based management.” However in cases such as explosions hearing loss has a much higher chance of being permanent than with sudden sensorneueral hearing loss. If the hearing loss has not gotten better or disappeared in a few weeks or months then the person may decide to wear a hearing aide to facilitate in his or hers hearing. Hearing aides can be expensive and not all insurance companies will pay for them. In this case many people may just have to live with their reduced hearing. References Louis , C. (2013, April 24). Subtler harm from barms: Some victims lose hearing . Retrieved from http://www.nytimes.com/2013/04/25/us/boston-bomb-victims-hidden-injury-hearingloss.html?_r=0 Saunders, G., & Griest , S. (2009). Hearing loss in veterans and the need for hearing loss prevention programs. Noise Health , 11(42), 14-21. Retrieved from http://www.noiseandhealth.org/article.asp?issn=14631741;year=2009;volume=11;issue=42;spage=14;epage=21;aulast=Saunders Schreiber , B., Agrup, C., Haskard , D., & Luxon , L. (2010). Sudden sensorineural hearing loss. THE LANCET, 375(9721), 1203-1211. Retrieved from http://www.sciencedirect.com/science/article/pii/S0140673609620717 Tun , C., Hogan , A., & Fitzharris, K. (2009). Hearing and vestibular dysfunction caused by-blast injuries and traumatic brain injuries. The Hearing Journal , 62(11), doi: 10.1097/01.HJ.0000364272.60094.e6