What? I can’t hear you!

Lightning strikes cause an average of 53 deaths per year in the US, killing about 10% of those who are struck. Strikes are well known to cause audiovestibular sequelae.

The first reported case of deafness after lightning was in 1879, and the most common cause of deafness is tympanic membrane rupture. However, both sensorineural hearing loss and conductive hearing loss have been described as well. Vertigo has also occurred after lightning strikes.

This article reviewed 15 studies to help describe ear damage caused by lightning. After describing the reported injuries, the authors then attempt to identify the root cause of the injuries. These are varied, and range from electrical conductance, to primary blast, to hypoxia, to anatomical disruption, to stress response, to vascular effects. They end by simply stating that the pathophysiology is “an unsolved conundrum.”

They recommend a management protocol for these injuries. It begins with otologic, vestibular, and neurologic assessments. They do recommend against early surgical repair for TM injuries. Psychiatric assessment is advised to help prevent and treat PTSD and persistent neurobehavioral disorder. The last recommendation is followup at 1 year to evaluate for delayed sequelae.

The article is worth it simply because it gives a logical treatment plan for the patient with inner ear problems after being struck by lightning.

Modayil PC, Lloyd GW, Mallik A, Bowdler DA. Inner ear damage following electric current and lightning injury: a literature review. Eur Arch Otorhinolaryngol. 2014 May;271(5):855-61 [PMID 23649510]