Blast-Related Otologic and Facial Nerve Injuries in Gaza

Explosive weapons used in densely populated settings often disproportionately injure craniofacial nerves and lead to otologic trauma. During the Israeli military invasion of Gaza, the collapse of referral pathways and surgical capacity constrained otologic and craniofacial care. The authors aimed to characterize otologic trauma and facial nerve palsy, and to identify predictors of hearing loss severity in this context. The authors conducted a retrospective cohort study of civilians with conflict-related otologic trauma presented to the Nasser Medical Complex in Palestine's Khan Yunis, Gaza Strip, between May 6 and July 6, 2025. Demographic, clinical, audiometric, and radiologic data were abstracted from clinical records. Among 110 patients (median age 30 y; 80% male), blast mechanisms accounted for ∼80% of injuries, and bilateral ear involvement was frequent. Facial palsy was documented in 10.9% of patients. Tympanic membrane (TM) pathology, ranging from small to subtotal perforations and hemotympanum, was common and showed a graded association with both conductive and sensorineural loss in unadjusted and adjusted models. Older age and longer time from injury independently predicted greater sensorineural severity, while facial palsy co-occurred with more severe left-sided losses. No patients underwent nerve exploration or repair.