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Case Studies from GWOT PowerPoint Presentation

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Published on : Mar 14, 2014
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Slide 1 - Case Studies from GWOT: This Isn’t Your Grandfather’s NIHL LtCol Angela Williamson OIC, Audiology and Speech Clinic Landstuhl Regional Medical Center, Germany
Slide 2 - Patients seen 48 - 72 hours post trauma In house for 3-7 days before departure to CONUS Average 20 flights/week from OEF/OIF 3 Staff Audiologists, 1 Speech Pathologist BTE stock aids for immediate fitting
Slide 3 - Case Studies from GWOT Cases drawn from one month period in Sept 07 Patients asked to relate the events, if they could recall them, whether HPD in place, location of blast related to their body Complaints include: Ear pain Muffled hearing, “cotton in ears” Heightened sound sensitivity - hyperacusis Tinnitus
Slide 4 - Hyperacusis Poorly understood, little research available Hyperacusis, Mechanisms, Diagnosis and Therapies By Baguley and Andersson, Plural Publishing Noise trauma ~ Hyperacusis ~ Depression PTSD Threat of death/seeing a death Fear reaction Hyper-arousal (sleep problems, irritability, concentration problems, hyper-vigilance, exaggerated startle response) Altered “gain” control in auditory system? Research needed
Slide 5 - Case 123 yr old, pre-deployment 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K +Hx OM +Hx PE tubes
Slide 6 - Case 123 yr old, after 1 IED blast 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K +Tinnitus +Hearing Aid
Slide 7 - Case 221 yr old, 1 RPG blast; RE TM perf 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K
Slide 8 - Case 328 yr old, 11B, pre-deployment 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K
Slide 9 - Case 328 yr old, 1 IED blast 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K +Tinnitus, 18dBSL +Hyperacusis +Hearing aids
Slide 10 - Case 422 yr old, bullet to Lt Temp region 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K x x x x x x x x mTBI Gait disturbance Type A, AU +Tinnitus ?Ossic disartic ?Fx ossicle
Slide 11 - Case 536 yr old, 2 IED blasts, +CAE use 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz Pre- blast injury Post- blast injury >10 K
Slide 12 - Case 536 yr old, 2 IED blasts, +CAE use 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz Pre- blast injury Post- blast injury >10 K
Slide 13 - Case 646 yr old, 5 IED blasts, +CAE use 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz Pre- blast injury Post- blast injury >10 K
Slide 14 - Case 646 yr old, 5 IED blasts, +CAE use 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz Pre- blast injury Post- blast injury >10 K
Slide 15 - RPG at Forward Operating Base Guard Tower Two patients seen in one week from same blast exposure Case 8 described the soldiers’ positions when impact hit Exact angle of RPG unknown Neither had HPD at time of attack Case 7 Case 8
Slide 16 - Case 720 yr old, 1 RPG attack 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K Lt TM perf Lt T-plasty, 12-07
Slide 17 - Case 824 yr old, 1 RPG attack 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K Bilat TM perf +Hearing aids mTBI +Tinnitus
Slide 18 - Case 931 yr old, 1 IED blast to left 20 40 60 80 100 0 .25 .50 1K 2K 3K 4K 6K 8K dB HL KHz >10 K NATO officer Severe tinnitus RE TM retracted to -200mm LE Type A
Slide 19 - Conclusion Ruptured TM High risk for cholesteatoma, need f/u for years Ask about hyperacusis, document it Talk about tinnitus, document it Consider use of Tinnitus Handicap Inventory Tinnitus match Talk about CAE - They work! Talk about APD, screen for it Dichotic digits HINT SSI-ICM Angela.Williamson@amedd.army.mil Angela.Williamson@us.af.mil