Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-3482-8

LETTER TO THE EDITOR

Re: Inner ear damage following electric current and lightning injury: a literature review Ophir Ilan • Mohammed Iqbal Syed Ilan Weinreb • John A. Rutka



Received: 9 December 2014 / Accepted: 25 December 2014 Ó Springer-Verlag Berlin Heidelberg 2015

Dear Editor, We have read with interest the article by Modayil et al. [1], recently published in your journal. While the authors have done a commendable job in reviewing the literature on the impact of electrical injury on the cochleovestibular system the review raises a few discrepancies that we would like to highlight. We agree with the authors that the pathophysiology of cochleovestibular damage following electrical injury is unclear. The authors further state that ‘‘there were no histological studies on the effect of the electrical current injury on the human audiovestibular system’’. To the contrary we would like to highlight the study by Youngs et al. [2] that describe a case of death related to lightning injury, yet whose temporal bone pathology explains the mechanism of electric injury. Further, the authors have misquoted the paper by Youngs et al. [2] describing ‘‘the post-temporal bone findings showing bilateral tympanic membrane perforations, with a collection of blood in the middle ear cleft including the mastoid’’ in a 21-year-old male struck by

lightning who died from complications following progressive neural degeneration and a delayed transverse myelitis. The temporal bone findings of this patient showed the middle ear and tympanic membranes intact [2] (Fig. 1, new and previously unpublished picture taken from the original pathology slides of that patient) and the inner ear showed almost complete absorption of the organ of Corti and extensive neural damage to the spiral ganglion and nerve (figures 2 and 3 in Youngs et al.). The injury pattern fits the electrical conductance theory in which damage to inner ear structures follows conductance of the electrical charge through the internal auditory canal to the inner ear. This model explains best the clinical finding of inner ear damage in people surviving lightning or electrical current injury.

This comment refers to the article available at doi:10.1007/s00405-013-2544-7. O. Ilan (&)  M. I. Syed  J. A. Rutka Department of Otolaryngology, Head and Neck Surgery, University Health Network, Toronto, ON, Canada e-mail: [email protected] I. Weinreb Department of Pathology, University Health Network, Toronto, ON, Canada

Fig. 1 H&E temporal bone histopathology of the right middle ear cleft showing an intact tympanic membrane and clear middle ear space of a patient with hearing loss after lightning injury

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Eur Arch Otorhinolaryngol Conflict of interest of interest.

The authors declare that they have no conflict

References 1. Modayil PC, Lloyd GW, Mallik A, Bowdler DA (2014) Inner ear damage following electric current and lightning injury: a literature review. Eur Arch Otorhinolaryngol 271(5):855–861

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2. Youngs R, Deck J, Kwok P, Hawke M (1988) Severe sensorineural hearing loss caused by lightning. A temporal bone case report. Arch Otolaryngol Head Neck Surg 114(10):1184–1187

Re: Inner ear damage following electric current and lightning injury: a literature review.

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