Abstract

Topicality: After the encroachment of Russian Federation on the territory of Ukraine and the beginning of the battle actions of high intensity the amount of injured with traumas, including blast injury (BI) grew in geometrical progression. An explosive trauma is characterized by many manifestations, many organs and systems can be simultaneously struck here, and wounds quite often are combined and united. One of the most widespread displays of BI is blast injury hearing loss that takes place as a basic or concomitant diagnosis in most injured in the zone of realization of battle actions. Acoustic trauma is the complex state due to its pathogenesis and manifestations that is difficult to cure. However, appropriate treatment is not always provided in a timely manner by otolaryngologist in case of combined and united injuries, taking into account the degree of danger of other injuries and the specifics of the military serviceman’s route at the stages of medical evacuation.

Aim: to learn routes and efficiency of providing the specialized medical help to the servicemen with acoustic trauma as a basic or concomitant diagnosis.

Materials and methods: The inspections and treatments of 103 servicemen were analysed with the basic or concomitant diagnosis of acoustic combat trauma that got the specialized medical help. The research envisaged the estimation of volume and order of providing the specialized medical help, the results of treatment at different terms of providing medical treatment. We analysed the data of anamnesis, the results of instrumental inspection, the time of staying on stationary treatment and its efficiency.

Results and discussions: According to the received data, the most patients got specialized medical help during the first 10 days after acoustic trauma (84%). However, not always such help was otorhinolaryngologic. Only 40% of servicemen received treatment in the specialized otorhinolaryngologic department concerning blast injury hearing loss. The majority of patients stayed at the surgical departments (24%), partly – in burn unit (5%), traumatology (12%), ophthalmology (3%), maxilla-facial (3%), thoracal (12%) departments with corresponding basic diagnoses. The inspections by otolaryngologist were conducted to all fighters in the cases analysed by us, however only 33% in the first 3 days, in another cases – already during on stationary treatment. In 36% cases acoustic trauma was accompanied by the posttraumatic breaks of ear-drums, in 94% patients received surgical treatment (myringoplasty, tympanoplasty). The united injury took place in 96% of injured, mainly as neurological pathologies (52%), traumatology pathologies (26%), comminuting wounds (60%), thermal traumas (6%). Practically all patients had middle degree of severity of their state (99%). The duration of treatment in department was 19,6±0,3 days. The improvement was inspected in 89% injured, without a substantial positive dynamic were 11 % of them. The best result of treatment had those servicemen that were examined by an otolaryngologist in an early term and to whom in good time the purposeful specialized treatment was appointed.

We divided all the examined patients in two groups. The first group with positive dynamics after treatment includes 91 servicemen and the 2 groups where treatment was not effective include 12 persons. Then we analysed all indexes in these groups separately and compared to each other. The specialized help was given in the first 10 days to 92% injured in the 1^st group and only to 25% in the 2^nd group. The deferred providing of medical help over 10 days from the moment of receiving acoustic trauma took place in majority of patients from the 2^nd group who did not have an improvement after the conducted treatment (in 75% cases).

Considerable influence on efficiency of treatment had the presence of concomitant damages, especially wounds and traumatology pathology. The wounds of locomotor system were observed in 255 servicemen of the 1^st group and in 33% of the 2^nd group, and wound of soft tissues, mainly shrapnel of different localization – in 59% injured of the 1^st group and in 67% in the 2^nd group.

The inspected patients in majority got medication treatment of blast injury hearing loss in obedience to the ratified protocols – 87% in the 1^st group, 67% in the 2^nd group. The beginning of the specialized treatment of acoustic trauma took place in first 7 days in 77% servicemen in the 1^st group and in 25% in the 2^nd group for the patients with insufficient efficiency of curative measures. The treatment of acoustic trauma began in terms after 7 days in 16% patients in the 1^st group and in 75% in the 2^nd group.

The most significant values for efficiency of the conducted treatment among the investigated factors has a term of beginning of providing specialized help from the moment of acoustic trauma defeat of the auditory system. The average index of such period in the group of patients with the effective result of treatment is 3,5 days and it was reliably (P<0,05) less than such index in the group of patients where the treatment was ineffective – 12,3 days.

Thus, on efficiency of medical help at a battle acoustic trauma, in obedience to our research influences the row of factors amongst which the most significant are the term of beginning of providing the specialized help from the moment of trauma and the presence and the character of concomitant damages.

Conclusions:

1. The patients with acoustic trauma got in the battle conditions are treated in obedience to the ratified clinical protocols of providing medical help to the servicemen with acoustic trauma on І, ІІ and ІІІ-IV levels put in an operation by Order of Command of Medical Forces of MFU from 05.06.2020 № 87. It is on the whole effective.
2. The row of factors influences on efficiency of treatment of blast injury hearing loss amongst which that most significant are the term of beginning of providing the specialized help from the moment of trauma and the presence and the character of concomitant damages and wounds.
3. The best efficiency of treatment of acoustic trauma is observed when there is qualified sorting of injured on the first stages of medical evacuation, timely evacuation of the injured on the specialized level, application of instrumental inspection for diagnostics and the most rapid application of purposeful treatment in obedience to the ratified clinical protocols.
4. If the injured with acoustic trauma has the combined and united defeats and the treatment and receive treatment in non-profile departments, it is desirable to inspect patients by otolaryngologist as quick as possible, to apply the special curative measures during the first 10 days after the trauma.
5. The best efficiency of treatment of acoustic trauma is observed when the specialized curative measures start in the first 7 days after the moment of trauma.

Key word: combat injury, acoustic trauma, auditory system, blast injury hearing loss.