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Correspondence

Thunderstorms and iPods — Not a Good iDea

N Engl J Med 2007; 357:198-199July 12, 2007DOI: 10.1056/NEJMc070260

Article

To the Editor:

The potential for permanent hearing loss due to prolonged use of personal stereo equipment, such as portable compact-disk or MP3 players, at high decibel levels has been well described in the literature.1 We have recently become aware of an additional, albeit uncommon, hazard associated with the use of such devices.

A 37-year-old man was brought to the emergency department at our hospital. He had been jogging in a thunderstorm, listening to his iPod, when an adjacent tree was struck by lightning. Witnesses reported that he was thrown approximately 8 ft (2.4 m) from the tree.

The patient had second-degree burns on his chest and left leg. In addition, two linear burns extended along his anterior chest and neck to the sides of his face, terminating in substantial burns in the external auditory meatus bilaterally, corresponding to the positions of his earphones at the time of the lightning strike. Both of his tympanic membranes were ruptured, and he had a severe conductive hearing deficit. He also had a mandibular fracture. Computed tomography of the mandible (Figure 1AFigure 1Computed Tomographic Scan of the Mandible and Temporal Bones in the Patient.) and of the temporal bones showed bilateral dislocation of the incudomalleolar joints (Figure 1B and 1C). Internal fixation of the mandibular fractures was performed and the perforations of the tympanic membranes were managed with the use of perichondrial grafting.

Although people may be struck directly by lightning, it is more common for the lightning to jump to a person from a nearby object, such as a tree — a phenomenon known as a side flash.2 Opisthotonic muscle contraction may project the victim some distance, leading to further injury from blunt trauma. Because of the high resistance of skin, the lightning is often conducted over the outside of the body (an effect known as a flashover); however, sweat and metallic objects in contact with the skin can disrupt the flashover, leading to the internal flow of current. Although the use of a device such as an iPod may not increase the chances of being struck by lightning,3 in this case, the combination of sweat and metal earphones directed the current to, and through, the patient's head. The mandibular fractures were probably caused by muscle contraction, since there were no external signs of injury to the face. The perforations of the tympanic membranes occurred as a result of the sudden heating and expansion of air around the current, leading to pressure waves. Perforations are commonly seen in patients who have been struck by lightning,4 although ossicular injuries appear to be rare.5

Eric J. Heffernan, M.B.
Peter L. Munk, M.D.
Luck J. Louis, M.D.
Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
ejheffernan@eircom.net

5 References

1. 1

   Fligor BJ, Cox LC. Output levels of commercially available portable compact disc players and the potential risk to hearing. Ear Hear 2004;25:513-527
   CrossRef | Web of Science | Medline

2. 2

   Mason AD, Crockett RK. When lightning strikes: a case report and review of the literature. Int Paediatr 2000;15:173-178
   

3. 3

   Farragher RM. Injury from lightning strike while using mobile phone: statistics and physics do not suggest a link. BMJ 2006;333:96-96
   CrossRef | Web of Science

4. 4

   Gluncic I, Roje Z, Gluncic V, Poljak K. Ear injuries caused by lightning: report of 18 cases. J Laryngol Otol 2001;115:4-8
   CrossRef | Web of Science | Medline

5. 5

   Meriot P, Veillon F, Garcia JF, et al. CT appearances of ossicular injuries. Radiographics 1997;17:1445-1454
   Web of Science | Medline

Citing Articles (5)

Citing Articles

1. 1

   Philippa Trevorrow. (2012) Technology running the world : The Nike+iPod kit and levels of physical activity. Loisir et Société / Society and Leisure 35, 131-154
   CrossRef

2. 2

   Dermatoses Resulting from Physical Factors. 2011:, 18-44.
   CrossRef

3. 3

   (2007) More on Thunderstorms and iPods. New England Journal of Medicine 357:14, 1447-1448
   Free Full Text

4. 4

   &NA;. (2007) Use of MP3 players during thunderstorms may result in injury. Nursing 37, 3
   CrossRef

5. 5

   Heffernan , Eric J. , Munk , Peter L. , Louis , Luck J. , . (2007) Thunderstorms and iPods — Two Reports of the Same Case. New England Journal of Medicine 357:7, 723-723
   Free Full Text

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