A person exposed to a blast may need to be referred to an ENT (otorhinolaryngologist) specialist for evaluation of aural (acoustic) blast injury.
Patient selection: blast injury
Absolute indications for ENT referral:
(1) temporal bone fracture
(2) persistent hearing loss > 72 hours after blast
(3) inability to perform duties due to perceived hearing loss
(4) tympanic membrane perforation persisting more then 8 weeks
(5) clear fluid draining from the ear
(6) any vertigo persisting more than 7 days
(7) facial nerve paralysis
(8) abnormal screening audiogram with any of the following:
(8a) hearing threshold > 45 dB at 3000 Hz
(8b) hearing threshold > 55 dB at 4000 Hz
(8c) hearing threshold > 35 dB at 500, 1000 or 2000 Hz
(8d) pure tone threshold average > 30 dB across 500, 1000 and 2000 Hz
Relative indications:
(1) debris in external auditory canal that does not clear with topical ear drops
(2) inability to visualize the tympanic membrane after treatment with topical ear drops
(3) persistent dizziness
(4) significant communication problems
(5) tinnitus that interferes with work or lifestyle (disabling)
