Acoustic effects of lightning.

The effects of lightning on the audiovestibular apparatus vary with the degree of injury. This depends on whether the individual is struck directly or indirectly by lightning. We reported two cases where lightning has caused trauma to audiovestibular apparatus and have reviewed the available literature. One patient was struck directly by lightning leading to rupture of the tympanic membrane and a conductive hearing loss. The other patient was struck indirectly via telephone cable and had a mixed hearing loss with tympanic membrane intact.