Bullet and Blast ENT Injuries in Counter-Insurgency Area.

Background: Many ENT injuries are not recognized easily, but they have the potential of increasing the morbidity.

Methods: ENT injuries managed in two tertiary care Level-IV hospitals between 2006 and 2007 were studied with a view to formulate strategy in efficient management of these cases.

Result: Emergency bags did not carry readymade packs to control nasal bleeds. Routinely screening of ears in all blast injury cases in the 'Blast Injury Program' helped in early identification of hearing loss. Lack of sufficient stenting of nasal cavities resulted in severe nasal stenosis which was difficult to repair. Splinters lodged in pharyngeal wall escaped detection, resulting in concealed haemorrhage and shock.

Conclusion: Nasal packs and epistaxis catheters must be included in emergency bags to minimize blood loss at first contact. Screening for ear trauma in all blast injuries increases detection rate and is beneficial to the soldier. Stenting of injured nasal cavities and early transfer to a tertiary care hospital could reduce morbidity. Plain radiography of head and neck areas could help detect splinters in vital areas and guide management.