The implications of physical injury on otovestibular and cognitive symptomatology following blast exposure

Objective. Identify a potential difference in the spectrum of otovestibular and cognitive symptoms in blast-exposed patients comparing individuals with or without significant extremity injuries. Study Design. Case series with chart review. Setting. A military tertiary care medical center. Subjects and Methods. All new patient referrals for otovestibular evaluation after a blast injury or exposure were identified in the electronic medical record. One hundred consecutive patients meeting these criteria were studied. Data including presence of severe extremity injuries, diagnosis of mild traumatic brain injury, symptoms of imbalance, vertigo, headache, tympanic membrane perforation, hearing loss, and tinnitus were collected and analyzed. Results. Of 100 patients included, 38 suffered severe extremity injuries. Those patients with severe extremity injuries were more likely to suffer from tympanic membrane perforations (58% vs 23%, P<.001, odds ratio [OR], 4.71, 95% confidence interval [CI], 1.96-11.33) and hearing loss (53% vs 23%, P = .002, OR, 3.81, 95% CI, 1.59-9.11). However, those without severe extremity injuries were more likely to suffer from imbalance (79% vs 32%, P <.001, OR, 8.17, 95% CI, 3.26-20.44) and vertigo (47% vs 2%, P < .001, OR, 32.52, 95% CI, 4.19-252.07) and more likely to have been diagnosed with a mild traumatic brain injury following blast exposure (66% vs 26%, P<.001, OR, 5.47, 95% CI, 2.24-13.36). Conclusion. Blast-exposed individuals who sustained severe extremity injuries reported significantly fewer cognitive and vestibular symptoms. In the aftermath of a blast, those who can walk away may have still sustained a significant injury. Specifically, they may suffer more long-term cognitive and vestibular symptoms than those with severe physical injuries.