Blast injury of the ear

147 soldiers, in whom 210 ears were blast-injured, were studied retrospectively during 1967-1986. The nature of eardrum perforations, hearing impairment, complications, changes over the course of time and different modes of treatment were reviewed. In 92.8 of the ears the perforation was up to half of the eardrum surface, most significantly of the lower part of the drum. In 75% the perforation closed spontaneously: in 40% within a month, in 59% within 2 months and in 73% within a year. Most had impaired hearing, of whom 74% had sensorineural or mixed hearing loss; 60% complained of tinnitus and/or vertigo. In 13% purulent discharge had accompanied the perforation and in 8% a cholesteatoma had developed 1-4 years after injury. The recommended treatment of blast injury is early patching of the perforation and surgical exploration a year later in cases with residual conductive hearing loss or cholesteatoma.