Shchuruk O, Shchuruk G, Shchuruk A, Malchuk A
SURGICAL TREATMENT OF THE CONSEQUENCES OF BLAST INJURY TO THE MIDDLE EAR. EXPERIENCE OF THE ENT DEPARTMENT OF THE VOLYN REGIONAL CLINICAL HOSPITAL
Shchuruk Olexander Z
Volyn Regional Clinical Hospital (Lutsk, Ukraine)
Email: sashashchuruk@gmail.com
ORCID ID: https://orcid.org/0009-0002-6906-5307
Scopus ID: 6504188237
Shchuruk Georgy Z
Volyn Regional Clinical Hospital (Lutsk, Ukraine)
Head of the Department of Otolaryngology
Email: georgeshchuruk@gmail.com
ORCID ID: https://orcid.org/0000-0003-1916-9589
Scopus ID: 6507542592
Shchuruk Anton G
Volyn Regional Clinical Hospital (Lutsk, Ukraine)
Email: antonshchuruk@gmail.com
ORCID ID: https://orcid.org/0009-0002-6857-8573
Malchuk Andriy
Volyn Regional Clinical Hospital (Lutsk, Ukraine)
Email: malchuk17041988@gmail.com
ORCID ID: https://orcid.org/0009-0000-0089-3038
Abstract
The article presents the experience of surgical treatment of long-term sequelae of blast-induced middle ear injury in patients operated on at the ENT Department of the Volyn Regional Clinical Hospital during 2022–2025. A retrospective analysis of 316 middle ear surgeries performed in 284 patients with persistent post-traumatic changes of the tympanic cavity was carried out. The type and severity of hearing loss, localization and size of tympanic membrane perforations, and the extent of surgical reconstruction were assessed. Intraoperative findings were systematized into epidermal, ossicular, and cicatricial post-traumatic changes.
Blast injury of the middle ear was characterized by pathological findings atypical for chronic suppurative otitis media, including epidermization of tympanic cavity structures, small round cholesteatomas, and implantation of epidermis into the mucosa of the medial wall. These changes were most frequently observed in patients with subtotal and total tympanic membrane perforations, whereas anterior perforations were rarely associated with such pathology. Post-traumatic ossicular changes were detected in 19.3% of cases and were mainly represented by fractures and dislocations of the incus and malleus. The incidence and type of ossicular injury were closely related to the extent of tympanic membrane damage.
Conventional microsurgical tympanoplasty techniques were shown to be effective in the surgical management of blast-related middle ear sequelae, providing stable anatomical restoration and satisfactory functional outcomes in most patients. The characteristic pattern of epidermal spread following blast injury requires increased surgical awareness and careful intraoperative inspection of the tympanic cavity. Endoscopic techniques should be used cautiously and primarily as an adjunct to microsurgical procedures for better visualization of hidden areas.
Key words: blast injury; acoustic barotrauma; middle ear; tympanic membrane perforation; tympanoplasty; ossicular chain lesions; cholesteatoma.
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