1. Addition of desk-top knowledge products “Aural Blast Injury: A Physician’s Guide to Acoustic Trauma” and “Aural Blast Injury: An Emergency Management Professional’s Guide to Acoustic Trauma”. These documents provide an overview of acoustic and physical symptoms, immediate duty restriction guidance, and evaluation and treatment recommendations appropriate for level of care.
2. Updated Veteran’s Affairs and Department of Defense acoustic trauma and auditory injury statistics.
3. Reduced the timing of transtympanic dexamethasone injections to three injections within a 10-day period as a salvage to oral steroids.
4. Deleted the requirement to taper oral steroid regimen of prednisone 60mg daily for 10 days.
5. Updated Appendix A: Dix-Hallpike Test to include graphics for both left and right maneuvers.
6. Updated Appendix B: Epley Maneuver to include both left and right clinician assisted positioning. Added graphics for both an exam table or the use of pillow or another object for positioning, if an exam table is not available.
7. Added Appendix D: DOTMLPF-P Considerations.
8. Added Appendix E: Class VIII and Additional Medical Material.