Dr. Richard Mabry: Blast Injury Hearing Loss

It’s always a pleasure to host Dr. Richard Mabry. His expertise was of great value in a manuscript I critiqued on hearing loss related to being in a confined space during an explosion. His next novel, Fatal Trauma, releases May 2015. 
Welcome back, Richard!

One of the possible medical scenarios for fiction is a hearing loss after a blast injury. I’ve read my share of detective stories and mysteries where gunshots occur, but only rarely have I seen addressed the ringing in the ears (tinnitus) and occasional brief hearing loss that may follow. But gunshots aren’t the only source of hearing change from loud sounds.

Let’s take an example of a blast in a confined space—a bomb, for instance. The first type of hearing loss to be considered would be due to the physical trauma to ears. Compression waves of a blast often rupture an eardrum, typically producing a triangular tear in the tympanic membrane. These sometimes heal spontaneously while other cases require a specialist to apply something like a paper patch to speed healing. In some situations a surgical procedure (tympanoplasty) is necessary.

Blast injuries can also disrupt the continuity of the three bones that form the chain conducting sound waves through the middle ear. This type of injury always requires surgical correction. However, assuming there is no damage to the inner ear (actual organ of hearing), all the injuries listed thus far are “conductive” losses—a hearing loss due to interruption of the conduction of sound.

When hearing is tested, levels are checked using earphones (air audiometry) and then a conductor of sound placed against the mastoid bone (bone audiometry). If there is a conductive loss, the air levels are decreased, but the bone levels remain fairly normal (because the sound short circuits the middle ear and goes direct to the organ of hearing). If both air and bone levels are down, the loss is caused by problems in the inner ear and is called “nerve” loss.

Noise, however produced, can also damage the inner ear (the curious can look up “Organ of Corti”), producing either a temporary or permanent nerve-type hearing loss. A rock concert may make a person’s ears ring and produce a temporary hearing loss (temporary threshold shift, or TTS) for up to a day or two.

Gunfire can do the same thing, and the bigger the gun, the bigger the bang, and the bigger the chance for noise-induced hearing loss (NIHL). This is sometimes temporary, but with repeated exposure or one huge sound exposure, the loss may be permanent. Although experimental treatments exist, at present there is no recognized treatment for NIHL and the tinnitus that accompanies it. How can you tell if the loss is permanent? You retest, because, as the saying goes, “only time will tell.”

Let me make a final point. What happens in your story isn’t as important as what happens in your life. Use ear protectors when you mow the lawn or at the shooting range. Encourage your kids to keep their exposure to noise down. And, if a sound makes your ears ring, avoid it in the future.


Richard Mabry is a retired physician, past Vice President of the American Christian Fiction Writers, and auth or of “medical suspense with heart.” His novels have been a semifinalist for International Thriller Writers’ debut novel, finalists for the Carol Award and Romantic Times’ Reader’s Choice Award, and winner of the Selah Award. His latest, Critical Condition, is his seventh published novel. You can follow Richard on his blog, on Twitter, and his Facebook fan page.

Tonsillectomy: Useful But Not Without Risk

I’ve been fascinated by the case of Jahi McMath, who is the girl who suffered surgical complications after a tonsillectomy and has been left brain dead. I’ll be discussing other aspects of this case next week but I thought I’d invite fellow medical musketeer and ENT physician, Dr. Richard Mabry, by to discuss the risks/benefits of this procedure.

I happily endorsed Richard’s forthcoming novel Critical Condition. It’s a great story and gives insight into that elusive area of the hospital– the OR. I hope you’ll check it out when it’s released in April.

Welcome back, Richard!

Any resident physician in otolaryngology (ear, nose and throat) can tell you that tonsillectomy is not a benign procedure. It’s very useful when indicated, but strict criteria for its consideration have been developed.  These include recurrent documented infections as well as sleep-disordered breathing. Attention to these criteria is important before tonsillectomy is considered.
Prior to the procedure, parents should feel free to ask questions or seek clarification of any points they don’t understand. Most physicians have instruction sheets that are given to help prepare families for the procedure.
The procedure itself is typically short—30 to 60 minutes—after which the child is observed in the recovery room until they are fully awake and stable. The child may be discharged later that day if they’re doing well, but sometimes complications necessitate an overnight stay.
The risk associated with a general anesthetic administered by competent personnel is tiny. Probably equally or more important is the possibility of complications occurring after the procedure. 
Undoubtedly, the number one risk is post-operative bleeding. If the child expectorates clots or large amounts of bright blood, parents should seek medical attention immediately. They are also warned to watch for and report fever, persistent vomiting, or difficulty breathing.
The tonsils receive their blood supply from branches of five different arteries, so bleeding—at surgery and afterward—can be a problem. To deal with this possibility, various methods—primarily application of caustic chemicals, use of ligatures, or various types of cauterization—have been traditionally been used. In recent years, surgical methods other than sharp dissection have become more popular. These include partial tonsillectomy and use of lasers to remove tonsil tissue. Thus far, the perfect solution hasn’t been found.
What are the risks associated with tonsillectomy? According to a recent journal article, the risk of dying from the operation ranges from 1 in 10,000 to 1 in 35,000 cases. Although mortality (i.e., dying) is rare, morbidity (i.e., complications) still occur. The most important, of course, is bleeding after the surgery. In one study, the incidence of bleeding was reported at from 2% to 3% of cases. The two most common times for post-tonsillectomy bleeding to occur are immediately after the surgery and after about a week, when scabs separate.
Does that mean that all parents should shy away from a tonsillectomy for their child? Not at all. It’s a very beneficial procedure when indicated and performed by a competent physician. But it behooves every parent to ask questions, learn what to watch for, and participate in the care of their child while they recover from the surgery.
Richard Mabry is a retired physician, past Vice President of the American Christian Fiction Writers, and author of “medical suspense with heart.” His novels have been a semifinalist for International Thriller Writers’ debut novel, finalists for the Carol Award and Romantic Times’ Reader’s Choice Award, and winner of the Selah Award. You can follow Richard on his blog, on Twitter, and his Facebook fan page.

Dr. Richard Mabry: Stress Test

I’m so pleased to host fellow medical thriller author Richard Mabry, MD today to Redwood’s Medical Edge. Richard has a new book out and we are running a contest to give away one FREE book to a commenter who is willing to post a review of the novel. In the comments section– please leave a note about what you’ll do to help promote Stress Test along with your e-mail address. Winner chosen at random. Must live in the USA. Winner drawn Saturday, April 20th at midnight and announced here on April 21, 2013.

Welcome back, Richard!

I love the books written by the late Robert B. Parker. You may not recognize his name, but Parker is the man who wrote the novels on which the TV shows featuring private detective Spenser and police chief Jesse Stone are based. I think one reason I like Spenser is that he’s just enough of a smart-aleck for me to identify with him. Someone once asked him why he was a private detective, and I love his answer: “Because I can’t sing and dance.”

What Spenser is saying is that he does what he does because he likes it and can do it well, as opposed to other choices he might have. So, when I’m asked why I write, I have two standard responses. The first, like Spenser, is “Because I can’t sing and dance.” The second is the oft-quoted and very true phrase about true writers: “We write because we can’t NOT write.” And there you have it.

I’m a retired physician. I was in solo private practice for 26 years, then spent another 10 as a professor at the University of Texas Southwestern Medical Center. Although I wrote or edited eight textbooks and had over 100 scientific papers published in professional journals, I never once thought about non-medical writing. Then my wife of 40 years died, and one tool I used to help me climb out of the deep depression I felt was journaling. When a friend read these raw journal entries, he encouraged me to turn them into a book. But I had no idea how to proceed.
From there, it was a matter of attending writer’s conferences, going through the cycle of write/edit/write/edit/write, and shopping the finished product to editors. Fortunately, The Tender Scar: Life After The Death Of A Spouse found a home with Kregel Publications, and it continues to minister to thousands each year. But while I was writing my non-fiction book, authors and editors urged me to try my hand at fiction. I tried it and found that I liked it.
Over the next four years, I quit once and almost quit another dozen times. You’ll notice I said I “almost quit” along the way. Why didn’t I quit? Because, time after time I found myself sneaking back to the computer to write some more. Truly, I couldn’t NOT write.
So that’s why I write “medical suspense with heart.” The genre fits. I enjoy the challenge. And…I can’t sing and dance.


Dr. Richard Mabry is a retired physician, past Vice-President of the American Christian Fiction Writers, and the author of five published novels of medical suspense. His books have been finalists in competitions including ACFW’s Carol Award and Romantic Times’ Inspirational Book of the Year. His last novel, Lethal Remedy, won a 2012 Selah Award from the Blue Ridge Mountain Christian Writers Conference. His most recent medical thriller, Stress Test (Thomas Nelson), was released in April, and will be followed by Heart Failure in October.