Acoustic and vestibular defects in lightning survivors

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Abstract
An analysis of our series of seven patients who have survived lightning strokes and a review of such cases mentioned in the world literature since 1960 reveals that the most common audiovestibular lesion in lightning survivors is tympanic membrane rupture. Of the various injury‐producing properties of lightning, the one most likely implicated in the pathogenesis of these lesions is the cylindrical shock wave which expands from the axis of the lighting bolt. The tympanic membrane in close proximity to the lightning bolt is suddenly stressed with enough force to cause its rupture.Lightning victims may also manifest various forms of neurosensory deafness and dizziness of central or vestibular origin. Possible explanations for these lesions are described but are primarily conjectural.Otologic management of these cases varies with the lesion sustained. Cochlear, retrocochlear and vestibular lesions are usually treated expectantly and medically as symptoms indicate. Surgical treatment is reserved for incapacitating vestibular problems unresponsive to conservative treatment and to reconstructive approaches to the tympanic membrane and middle ear when indicated.

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