Download PDF
J Am Acad Audiol 1999; 10(09): 467-483
DOI: 10.1055/s-0042-1748536
Original Article

One-Year Vestibular and Balance Outcomes of Oklahoma City Bombing Survivors

Luann E. Van Campen
Department of Otorhinolaryngology, Section of Audiology, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma
Currently at Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Biomedical and Behavioral Science, Cincinnati, Ohio
,
J. Michael Dennis
Department of Otorhinolaryngology, Section of Audiology, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma
,
Sandra B. King
Department of Otorhinolaryngology, Section of Audiology, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma
,
Renee C.R. Hanlin
Department of Otorhinolaryngology, Section of Audiology, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma
,
Amy M. Velderman
The Hough Ear Institute, Oklahoma City, Oklahoma; currently Richardson Independent Schools, Prairie Creek Elementary, Richardson, Texas
› Author Affiliations
› Further Information
  PDF Download  Permissions and Reprints

Abstract

This multisite investigation assessed subjective, behavioral, and objective balance function in 30 blast survivors. Subjects with vertigo, dizziness, or imbalance were screened (n = 6) or evaluated (n = 27) during 1 year. Tests included a questionnaire, electronystagmography (ENG), and computerized dynamic posturography (CDP). Ninety-seven percent of subjects were located inside a building during the blast, and 63 percent of subjects experienced dys-equilibrium within 48 hours. Forty-three percent of symptoms could not be attributed to head injury. Sixty percent of subjects had abnormal ENG and/or CDP; ENG abnormalities mostly were peripheral or nonlocalizing, whereas CDP patterns were “vestibular,” “surface dependent,” and “physiologically inconsistent.” At 1-year postblast, 55 percent of initially abnormal CDP results were normal, and 72 percent of subjects said symptoms were unchanged or occurred intermittently. A serial, test battery approach is recommended to assess symptoms. Blast-related dysequilibrium had clinically significant manifestations and should be considered a valid component of aural blast injury.

Abbreviations: BPPV = benign paroxysmal positioning vertigo, CDP = computerized dynamic posturography, dB pSPL = decibel re: peak sound pressure level, ENG = electronystagmography, MCT = motor control test, psi = air pressure measured in pounds per square inch, Q = quarterly evaluations, SHA = smooth harmonic acceleration, SOT = sensory organization test, TNT = trinitrotoluene

Key Words

Acoustic trauma - computerized dynamic posturography - dizziness - electronystagmography - imbalance - vertigo - vestibular blast injury


Publication History

Article published online:
05 May 2022

© 1999. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • Bailey KE, Sloane PD, Mitchell M, Preisser J. (1993). Which primary care patients with dizziness will develop persistent impairment? Arch Fam Med 2: 847–852.
  • Baker WE. (1973). Explosions in Air. San Antonio, TX: Wilfred Baker Engineering.
  • Barber HO, Wright G. (1973). Positional nystagmus in normals. Adv Otorhinolaryngol 19: 276.
  • Barrett K, Ward AB, Bougher A, Jones M, Mychalkiw W (1994). Sequelae of minor head injury: the natural history of post-concussive symptoms and their relationship to loss of consciousness and follow-up. J Accid Emerg Med 11: 79–84.
  • Britton BH. (1986). Vestibular responses to pressure variations: a review. Otolaryngol Head Neck Surg 95: 516–522.
  • Brookler KH, Rubin W. (1993). A practical atlas of basic patterns of ENG, rotary chair testing and posturogra-phy. In: Arenberg IK, ed. Dizziness and Balance Disorders. New York: Kugler, 429–450.
  • Cawthorne T. (1944). The physiological basis for head exercises. J Chart Soc Physiother 30: 106-107.
  • Cevette MJ, Puetz B, Marion MS, Wertz ML, Muenter MD. (1995). A physiologic performance on dynamic pos-turography. Otolaryngol Head Neck Surg 112: 676–688.
  • Chandler DW, Edmond CV. (1997). Effects of blast overpressure on the ear: case reports. J Am Acad Audiol 8: 81–88.
  • Clark S, Rees T. (1977). Posttraumatic endolymphatic hydrops. Arch Otolaryngol 103: 725–726.
  • Collins EG. (1948). Aural trauma caused by gunfire. J Laryngol Otol 62: 358–390.
  • Cooksey FS. (1946). Rehabilitation in vestibular injuries. Proc R Soc Med 39: 273.
  • Cyr DG. (1990). Vestibular system assessment. In: Rintelmann WF, ed. Hearing Assessment. 2nd ed. Austin, TX: Pro Ed, 739–803.
  • Cyr DG. (1991, March). Computerized Dynamic Posturography: Patterns of Dysfunction. Paper presented at the Keystone-ENT Conference, Keystone, CO.
  • Evans M. (1976). Physiological and psychological effects of infrasound at moderate intensities. In: Tempest W, ed. Infrasound and Low-Frequency Vibration. New York: Academic Press, 97–113.
  • Hamid MA. (1996). Dynamic posturography [letter to the editor]. Otolaryngology Head Neck Surg 114: 842–843.
  • Hinchcliffe R, Coles RR, King PR (1992). Occupational noise induced vestibular malfunction? Br J Industr Med 49: 63–65.
  • Igarashi M. (1984). Vestibular compensation: an overview. Acta Otolaryngolog Suppl (Stockh) 406: 78–82.
  • Juntunen J, Ylikoski J, Ojala M, Matikainen E, Ylikoski M, Vaheri E. (1987). Postural body sway and exposure to high-energy impulse noise. Lancet 2: 261–264.
  • Kerr AG. (1978). Blast injuries to the ear. Practitioner 221: 677–682.
  • Kerr AG. (1980). Trauma and the temporal bone: the effects of blast on the ear. J Laryngol Otol 94: 107–110.
  • Kerr AG, Byrne JE. (1975). Concussive effects of bomb blast on the ear. J Laryngol Otol 89: 131–143.
  • Korkis FB. (1952). Critical review: blast injuries of the ear. J Laryngol Otol 66: 95–102.
  • Kumagami H. (1992). Endolymphatic hydrops induced by noise exposure. Auris Nasus Larynx 19: 95–104.
  • Lim D, Dunn D, Johnson D, Moore T. (1982). Trauma of the ear from infrasound. Acta Otolaryngol (Stockh) 94: 213–231.
  • Lipp M, Longridge NJ. (1994). Computerized dynamic posturography: its place in the evaluation of patients with dizziness and imbalance. J Otolaryngol 23: 177–183.
  • Malonee S, Shariat S, Stennies G, Waxweiler R, Hogan D, Jordan F. (1996). Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA 276: 382–387.
  • Man A, Segal S, Naggan L. (1980). Vestibular involvement in acoustic trauma (an electronystagmographic study). J Laryngol Otol 94: 1395–1400.
  • Mangabeira-Albernaz P, Covell W, Eldridge D. (1959). Changes in the vestibular labyrinth with intense sound. Laryngoscope 69: 1478–1493.
  • McCabe B, Lawrence M. (1958). The effects of intense sound on the non-auditory labyrinth. Acta Otolaryngol (Stockh) 49: 147–157.
  • McReynolds G, Guilford F, Chase G. (1949). Blast injuries to the ear. Arch Otolaryngol 50: 1–8.
  • Nashner LM. (1993a). Computerized dynamic posturography. In: Jacobson GP, Newman CW, Kartush JM, eds. Handbook of Balance Function Testing. St. Louis: Mosby Year Book, 280–307.
  • Nashner LM. (1993b). Computerized dynamic posturography: clinical applications. In: Jacobson GP, Newman CW, Kartush JM, eds. Handbook of Balance Function Testing. St. Louis: Mosby Year Book, 308–334.
  • Pahor AL. (1981). The ENT problems following the Birmingham bombings. J Laryngol Otol 95: 399–406.
  • Paparella M, Mancini F. (1983). Trauma and Meniere's syndrome. Laryngoscope 93: 1004–1012.
  • Parker DE. (1976). Effects of sound on the vestibular system. In: Tempest W, ed. Infrasound and Low-Frequency Vibration. New York: Academic Press, 151–185.
  • Rubin AM, Woolley SM, Dailey VM, Goebel JA. (1995). Postural stability following mild head or whiplash injuries. Am J Otol 16: 216–221.
  • Shupak A, Doweck I, Nachtigal D, Spitzer O, Gordon C. (1993). Vestibular and audiometric consequences of blast injury to the ear. Arch Otolaryngol Head Neck Surg 119: 1362–1367.
  • Shupak A, Bar-El E, Podoshin L, Spitzer O, Gordon CR, Ben-David J. (1994). Vestibular findings associated with chronic noise induced hearing impairment. Acta Otolaryngol (Stockh) 114: 579–585.
  • Singh AP, Prasad U, Kumar N. (1983). Blast injuries of the ear. Sing Med J 24: 367–373.
  • Singh D, Ahluwalia KJ. (1968). Blast injuries of the ear. J Laryngol Otol 82: 1017–1028.
  • Smith PF, Curthoys IS. (1989). Mechanisms of recovery following unilateral labyrinthectomy: a review. Brain Res Rev 14: 155–180.
  • Sullivan M, Clark MR, Katon WJ, Fischl M, Russo J, Dobie RA, Voorhees R. (1993). Psychiatric and otologic diagnoses in patients complaining of dizziness. Arch Intern Med 153: 1479–1484.
  • U.S. Department of the Army. (1990). Structures to Resist the Effects of Accidental Explosions. Technical manual TM 5-1300. Washington, DC: U.S. Department of the Army.
  • Van Campen L, Dennis J, Hanlin R, King S, Velderman A. (1999). One-year audiologic monitoring of individuals exposed to the 1995 Oklahoma City bombing. J Am Acad Audiol 10: 231–247.
  • Van Eyck M. (1974). Sound-produced labyrinthine trauma. Arch Otolaryngol 100: 465–466.
  • Yelverton JT, Johnson DL, Axelsson H. (1996). Review of nonauditory effects of blast overpressure. In: Axelsson A, Borchgrevink HM, Hamernik RP, Hellstrom Ρ, Henderson D, Salvi R, eds. Scientific Basis of Noise-induced Hearing Loss. New York: Thieme, 447–461.
  • Ylikoski J. (1987). Impulse noise induced damage in the vestibular end organs of the guinea pig. Acta Otolaryngol (Stockh) 103: 415–421.
  • Ylikoski J. (1988). Delayed endolymphatic hydrops syndrome after heavy exposure to impulse noise. Am J Otol 9: 282–285.
  • Ylikoski J, Juntunen J, Matikainen E, Ylikoski M, Ojala M. (1988). Subclinical vestibular pathology in patients with noise-induced hearing loss from intense impulse noise. Acta Otolaryngol (Stockh) 105: 558–563.