1
|
Harris M, Nguyen A, Brown NJ, Picton B, Gendreau J, Bui N, Sahyouni R, Lin HW. Mild Traumatic Brain Injury and the Auditory System: An Overview of the Mechanisms, Clinical Presentations, and Current Diagnostic Modalities. J Neurotrauma 2024; 41:1524-1532. [PMID: 37742111 DOI: 10.1089/neu.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Abstract
The acute and long-term consequences of mild traumatic brain injury (mTBI) are far reaching. Though it may often be overlooked due to the now expansive field of research dedicated to understanding the consequences of mTBI on the brain, recent work has revealed that substantial changes in the vestibulo-auditory system can also occur due to mTBI. These changes, termed "labyrinthine" or "cochlear concussion," include hearing loss, vertigo, and tinnitus that develop after mTBI in the setting of an intact bony labyrinthine capsule (as detected on imaging). In the review that follows, we focus our discussion on the effects of mTBI on the peripheral structures and pathways of the auditory and vestibular systems. Although the effects of indirect trauma (e.g., noise and blast trauma) have been well-investigated, there exists a profound need to improve our understanding of the effects of direct head injury (such as mTBI) on the auditory and vestibular systems. Our aim is to summarize the current evidentiary foundation upon which labyrinthine and/or cochlear concussion are based to shed light on the ways in which clinicians can refine the existing modalities used to diagnose and treat patients experiencing mTBI as it relates to hearing and balance.
Collapse
Affiliation(s)
- Mark Harris
- Department of Neurological Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Andrew Nguyen
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nolan J Brown
- Department of Neurological Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Bryce Picton
- Department of Neurological Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Nicholas Bui
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, San Diego, California, USA
| | - Harrison W Lin
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| |
Collapse
|
2
|
Kim CH, Kim H, Jung T, Lee DH, Shin JE. Clinical characteristics of benign paroxysmal positional vertigo after traumatic brain injury. Brain Inj 2024; 38:341-346. [PMID: 38297437 DOI: 10.1080/02699052.2024.2310790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION The aim of the present study was to evaluate the characteristics of brain injury and to assess the relationship between them and treatment outcomes in patients with traumatic benign paroxysmal positional vertigo (t-BPPV). MATERIALS AND METHODS Sixty-three consecutive patients who were diagnosed with BPPV within 2 weeks after head trauma were included. RESULTS Cerebral concussion, intracranial hemorrhages (ICH), skull fracture without ICH, and hemorrhagic contusion were observed in 68%, 24%, 5%, and 3% of t-BPPV patients, respectively. BPPV with single canal involvement was observed in 52 (83%) patients and that with multiple canal involvement was observed in 11 (17%) patients. The number of treatment sessions was not significantly different according to the cause of head trauma (p = 0.252), type of brain injury (p = 0.308) or location of head trauma (p = 0.287). The number of recurrences was not significantly different according to the cause of head trauma (p = 0.308), type of brain injury (p = 0.536) or location of head trauma (p = 0.138). CONCLUSION The present study demonstrated that there were no significant differences in treatment sessions until resolution and the mean number of recurrences according to the type of brain injury.
Collapse
Affiliation(s)
- Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hansol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Taesik Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Stahl AN, Racca JM, Kerley CI, Anderson A, Landman B, Hood LJ, Gifford RH, Rex TS. Comprehensive behavioral and physiologic assessment of peripheral and central auditory function in individuals with mild traumatic brain injury. Hear Res 2024; 441:108928. [PMID: 38086151 DOI: 10.1016/j.heares.2023.108928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
Auditory complaints are frequently reported by individuals with mild traumatic brain injury (mTBI) yet remain difficult to detect in the absence of clinically significant hearing loss. This highlights a growing need to identify sensitive indices of auditory-related mTBI pathophysiology beyond pure-tone thresholds for improved hearing healthcare diagnosis and treatment. Given the heterogeneity of mTBI etiology and the diverse peripheral and central processes required for normal auditory function, the present study sought to determine the audiologic assessments sensitive to mTBI pathophysiology at the group level using a well-rounded test battery of both peripheral and central auditory system function. This test battery included pure-tone detection thresholds, word understanding in quiet, sentence understanding in noise, distortion product otoacoustic emissions (DPOAEs), middle-ear muscle reflexes (MEMRs), and auditory evoked potentials (AEPs), including auditory brainstem responses (ABRs), middle latency responses (MLRs), and late latency responses (LLRs). Each participant also received magnetic resonance imaging (MRI). Compared to the control group, we found that individuals with mTBI had reduced DPOAE amplitudes that revealed a compound effect of age, elevated MEMR thresholds for an ipsilateral broadband noise elicitor, longer ABR Wave I latencies for click and 4 kHz tone burst elicitors, longer ABR Wave III latencies for 4 kHz tone bursts, larger MLR Na and Nb amplitudes, smaller MLR Pb amplitudes, longer MLR Pa latencies, and smaller LLR N1 amplitudes for older individuals with mTBI. Further, mTBI individuals with combined hearing difficulty and noise sensitivity had a greater number of deficits on thalamic and cortical AEP measures compared to those with only one/no self-reported auditory symptoms. This finding was corroborated with MRI, which revealed significant structural differences in the auditory cortical areas of mTBI participants who reported combined hearing difficulty and noise sensitivity, including an enlargement of left transverse temporal gyrus (TTG) and bilateral planum polare (PP). These findings highlight the need for continued investigations toward identifying individualized audiologic assessments and treatments that are sensitive to mTBI pathophysiology.
Collapse
Affiliation(s)
- Amy N Stahl
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN USA; Department of Ophthalmology & Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jordan M Racca
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA; Collaborative for STEM Education and Outreach, Vanderbilt Peabody College of Education, Vanderbilt University, Nashville, TN USA
| | - Cailey I Kerley
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Adam Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bennett Landman
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Linda J Hood
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - René H Gifford
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Tonia S Rex
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| |
Collapse
|
4
|
Prasad BK, Jerath V, Shukla S. A Prospective Observational Study on the Pattern of Hearing Loss and Its Recovery in Temporal Bone Fractures. Indian J Otolaryngol Head Neck Surg 2023; 75:3686-3695. [PMID: 37974844 PMCID: PMC10645703 DOI: 10.1007/s12070-023-04036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 11/19/2023] Open
Abstract
To study the pattern of hearing loss and its recovery in cases of temporal bone fractures. 95 cases of temporal bone fractures, selected from head injury cases, were examined in Trauma centre or Intensive care unit or in Otorhinolaryngology department in a tertiary care Army Hospital. Hearing loss was assessed by pure tone audiometry. The recovery pattern of hearing loss in each case was studied by further follow up audiometry after 30 days, 60 days and 90 days. Hearing loss was detected in 71 cases. Majority (42%) had mild degree of hearing loss followed by severe (18%). There were equal numbers of sensorineural and conductive hearing loss. Hearing loss was higher in transverse (62%) and oblique (27%) fractures compared to longitudinal (11%). Severe, profound and high frequency hearing loss were more associated with otic capsule violating fractures as compared to otic capsule sparing fractures. Complete recovery to under 25dBHL as seen on day 30, 60 and 90 were 27%, 32% and 59% respectively. Hearing loss, though under reported, is an important complication which often occurs in all types of temporal bone fractures. Conductive hearing loss is as common as sensorineural one. Otic capsule violating fracture is more likely to cause severe and profound hearing loss. Complete recovery is not the rule.
Collapse
Affiliation(s)
- B K Prasad
- Present Address: Rama Medical College Hospital & Research Centre, Kanpur, Uttar Pradesh 209217 India
| | - Varun Jerath
- Present Address: Army Hospital (R&R), New Delhi, 110010 India
| | - Shambhavi Shukla
- Present Address: Command Hospital (Eastern Command) Kolkata, Alipore Road, Kolkata, 700027 India
| |
Collapse
|
5
|
Bilal N, Orhan İ, Turna K, Doğaner A, Oruk V. Comparisons of Auditory and Vestibular Functions After Septorhinoplasty Performed with the Micro-compass Saw Technique and the Classical Technique. Aesthetic Plast Surg 2023; 47:2561-2572. [PMID: 37731076 DOI: 10.1007/s00266-023-03610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 09/22/2023]
Abstract
AIM To evaluate hearing and labyrinth functions following different osteotomy types (micro-compass saw, osteotome, and no osteotomy) performed in septorhinoplasty operations. MATERIAL AND METHOD The study included 74 patients operated between January 2020 and March 2022, separated into 3 groups: Group 1: 24 patients (16 females and 8 males): osteotome was used for the osteotomy; Group 2: 24 patients (12 females and 12 males): micro-saw was used for osteotomy; and Group 3: 26 patients (17 females and 9 males): open technique septoplasty with no osteotomy. At 1 day before and 1 week after the operation, all the patients underwent audiological examination, tympanometry, vestibular evoked myogenic potentials (c-VEMP), video head impulse test (v-HIT), videonystagmography (VNG), and distortion product otoacoustic emission (DPOAE) tests. RESULTS In the c-VEMP tests, significant differences were determined between the groups in respect of N1, P1, and N1-P1 latencies and N1-P1 amplitudes before and after the operation. In the v-HIT test, the change in right-side posterior gain postoperatively was statistically significant in the micro-saw group (p<0.05). The postoperative right lateral canal values were determined to be statistically significantly increased in the micro-saw group compared to the osteotome group (p<0.05). CONCLUSION This is the only study in the literature to have determined vestibular effects with the evaluation of such a wide range of techniques. Previous studies in the literature have found no effect of osteotomy technique on the balance and hearing systems. The results of this study demonstrated that the preoperative and postoperative difference between the osteotomy techniques had an effect on the balance system. The change in the balance tests following an operation with classic osteotomy shows a greater predisposition to benign positional vertigo. In this sense, the micro-saw can be considered safer. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Nagihan Bilal
- Faculty of Medicine, Department of Otorhinolaryngology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
| | - İsrafil Orhan
- Faculty of Medicine, Department of Otorhinolaryngology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Kenan Turna
- Faculty of Medicine, Department of Audiology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Adem Doğaner
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Vedat Oruk
- Private Bursa Medicabil Hospital, Otorhinolaryngology Clinic, Bursa, Turkey
| |
Collapse
|
6
|
Bansal S, Preetam C, Patnaik A, Sahu RN. Assessment of Hearing Loss in Minor Head Injury: A Prospective Study. Asian J Neurosurg 2022; 17:595-599. [PMID: 36570745 PMCID: PMC9771613 DOI: 10.1055/s-0042-1757431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction Hearing loss following a head injury is common and well known. The numbers of road traffic accidents have increased recently, with minor head injuries being very common, and usually go unreported. Hearing loss after a minor head injury is often unnoticed. Available literature is limited in this regard. Objective This study was done to assess hearing loss in patients with minor head injuries and to define its natural history and progression/regression by a serial assessment of hearing. Methods This prospective study was done in the Department of Neurosurgery, AIIMS, Bhubaneshwar, Odisha, India, for a period of 24 months to look at the profile of hearing levels of patients presenting with history suggestive of minor head injury. Results This study has shown that some form of hearing loss is common after a minor head injury and should be evaluated in all patients to detect subclinical hearing loss. A significant number of patients having minimal or a mild degree of hearing loss, if managed properly, improve to preinjury status. Distortion product oto-acoustic emission testing should be used as the screening and follow-up tool. Conclusion This study highlights the importance of hearing assessment in minor-head-injury patients and the prognosis of recovery as per the severity of hearing loss and head injury.
Collapse
Affiliation(s)
- Sumit Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India,Address for correspondence Sumit Bansal, MCh (Neurosurgery) Department of Neurosurgery, All India Institute of Medical SciencesBhubaneswar, 751019, OrissaIndia
| | - Chappity Preetam
- Department of ENT, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Ashis Patnaik
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Rabi Narayan Sahu
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| |
Collapse
|
7
|
Albrecht A, Schipper J. [Traumatology of the lateral skull base]. HNO 2022; 70:743-750. [PMID: 36036809 DOI: 10.1007/s00106-022-01212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/04/2022]
Abstract
The most common cause of lateral skull base fractures are still road traffic accidents, followed by falls. The radiologic classification into otic capsule-sparing or otic capsule-violating fractures correlates well with an increased risk of injury to the sensitive structures of the middle ear with otic capsule-violating fractures. In case of immediate onset complete facial nerve paralysis, decompression surgery is generally recommended if bony impingement can be demonstrated on high-resolution CT of the temporal bone. For many other facials nerve complications, recent publications have achieved good to excellent facial nerve recovery rates with watchful waiting under conservative treatment with prednisolone administration.
Collapse
Affiliation(s)
- Angelika Albrecht
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Jörg Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| |
Collapse
|
8
|
Parker A, Skoe E, Tecoulesco L, Naigles L. A Home-Based Approach to Auditory Brainstem Response Measurement: Proof-of-Concept and Practical Guidelines. Semin Hear 2022; 43:177-196. [PMID: 36313050 PMCID: PMC9605808 DOI: 10.1055/s-0042-1756163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Broad-scale neuroscientific investigations of diverse human populations are difficult to implement. This is because the primary neuroimaging methods (magnetic resonance imaging, electroencephalography [EEG]) historically have not been portable, and participants may be unable or unwilling to travel to test sites. Miniaturization of EEG technologies has now opened the door to neuroscientific fieldwork, allowing for easier access to under-represented populations. Recent efforts to conduct auditory neuroscience outside a laboratory setting are reviewed and then an in-home technique for recording auditory brainstem responses (ABRs) and frequency-following responses (FFRs) in a home setting is introduced. As a proof of concept, we have conducted two in-home electrophysiological studies: one in 27 children aged 6 to 16 years (13 with autism spectrum disorder) and another in 12 young adults aged 18 to 27 years, using portable electrophysiological equipment to record ABRs and FFRs to click and speech stimuli, spanning rural and urban and multiple homes and testers. We validate our fieldwork approach by presenting waveforms and data on latencies and signal-to-noise ratio. Our findings demonstrate the feasibility and utility of home-based ABR/FFR techniques, paving the course for larger fieldwork investigations of populations that are difficult to test or recruit. We conclude this tutorial with practical tips and guidelines for recording ABRs and FFRs in the field and discuss possible clinical and research applications of this approach.
Collapse
Affiliation(s)
- Ashley Parker
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut
- Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut
- Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Erika Skoe
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut
- Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut
- Cognitive Sciences Program, University of Connecticut, Storrs, Connecticut
| | - Lee Tecoulesco
- Cognitive Sciences Program, University of Connecticut, Storrs, Connecticut
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Letitia Naigles
- Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut
- Cognitive Sciences Program, University of Connecticut, Storrs, Connecticut
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| |
Collapse
|
9
|
Choi JE, Chang YR, Mun IK, Jung JY, Lee MY, Yun JH. Inner Ear Symptoms Are Prevalent in Patients with High Head Abbreviated Injury Scale Scores after Blunt Head Trauma. Audiol Neurootol 2021; 27:56-63. [PMID: 34515057 DOI: 10.1159/000518189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The purpose of this article was to determine the prevalence of inner ear symptoms in patients with blunt head trauma and to explore whether the severity of head trauma was associated with the incidence of such symptoms. METHODS We performed a retrospective review of 56 patients admitted with blunt head trauma who underwent audiovestibular evaluation within 1 month after injury. Two scales were used to measure the severity of trauma; these were the Glasgow Coma Scale (GCS) and the Head Abbreviated Injury Scale (H-AIS). Patients with sensorineural-type hearing loss, or dizziness with nystagmus, were considered to have inner ear symptoms. RESULTS About half of all patients (45%) with blunt head trauma showed trauma-related inner ear symptoms. Patients with inner ear symptoms were significantly more likely to have H-AIS scores ≥4 than those without inner ear symptoms (p = 0.004), even without concomitant temporal bone fracture (p > 0.05). Also, patients with inner ear symptoms required a statistically significantly longer time (measured from admission) before undergoing their ontological evaluations than did those without such symptoms (p = 0.002), possibly due to prolonged bed rest and use of sedatives. CONCLUSION Thus, detailed history-taking and early evaluation using trauma scales are essential for all patients suffering from severe head trauma. It may be necessary to initiate early treatment of traumatic inner ear diseases.
Collapse
Affiliation(s)
- Ji Eun Choi
- Department of Otorhinolaryngology - Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Ye Rim Chang
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Kwon Mun
- Department of Otorhinolaryngology - Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jae Yun Jung
- Department of Otorhinolaryngology - Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Min Young Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jung-Ho Yun
- Department of Neurosurgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
| |
Collapse
|
10
|
Grzesiak M, Carender W, Basura GJ. Posttraumatic Dizziness: Navigating the Maze Towards Accurate Vestibular Diagnosis and Treatment. Otol Neurotol 2021; 42:e573-e578. [PMID: 33967250 DOI: 10.1097/mao.0000000000003035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Highlight the importance of establishing a differential diagnosis to identify and treat multiple origins of dizziness in a patient following traumatic brain injury (TBI). PATIENT 73-year-old man with TBI and temporal bone fracture developed posttraumatic bilateral multiple canal benign paroxysmal positional vertigo (BPPV). INTERVENTION Multi-disciplinary diagnostic evaluation and vestibular rehabilitation (VR) treatment focused on canalith repositioning maneuvers (CRMs) and central adaptation. MAIN OUTCOME MEASURES Diagnostic imaging, audiometric testing, clinical evaluation including video recordings of patterns of nystagmus, Dizziness Handicap Inventory (DHI). RESULTS Systematic clinical examination identified multiple semicircular canal BPPV in addition to a suspected underlying unilateral hypofunction. Treatment focused on the appropriate CRMs and adaptation exercises. DHI scores improved significantly and patient returned to work and recreational activities. CONCLUSION This Clinical Capsule Report highlights the importance of a comprehensive clinical evaluation of the TBI patient with dizziness when making an accurate diagnosis and treatment plan. Due to the complexity of differentiating between multiple canal BPPV in addition to other central and vestibular disorders, it is imperative for the clinician to have a clear understanding of nystagmus patterns for multicanal BPPV as well as other vestibular pathology.
Collapse
Affiliation(s)
- Melissa Grzesiak
- Department of Otolaryngology/Head and Neck Surgery, Michigan Balance-Vestibular Testing and Rehabilitation
- Division of Otology/Neurotology-Skull Base Surgery, Department of Otolaryngology/Head and Neck Surgery, Michigan Medicine, The University of Michigan, Ann Arbor, Michigan
| | - Wendy Carender
- Department of Otolaryngology/Head and Neck Surgery, Michigan Balance-Vestibular Testing and Rehabilitation
- Division of Otology/Neurotology-Skull Base Surgery, Department of Otolaryngology/Head and Neck Surgery, Michigan Medicine, The University of Michigan, Ann Arbor, Michigan
| | - Gregory J Basura
- Division of Otology/Neurotology-Skull Base Surgery, Department of Otolaryngology/Head and Neck Surgery, Michigan Medicine, The University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
11
|
Kozin ED, Knoll RM, Bhattacharyya N. Association of Pediatric Hearing Loss and Head Injury in a Population-Based Study. Otolaryngol Head Neck Surg 2021; 165:455-457. [PMID: 33494650 DOI: 10.1177/0194599820982904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic brain injury (TBI) is the leading cause of acquired long-term disability during childhood, and it may result in wide range of negative developmental consequences. Auditory dysfunction is generally recognized to be a possible sequela of pediatric TBI. Unfortunately, few contemporary studies have quantified the association between head injury and hearing loss in the pediatric population. The National Survey of Children's Health (NSCH) for the combined years 2017-2018 was used to determine the association of hearing loss with TBI. Deafness or problems with hearing were more commonly reported in children with a history or current brain injury/concussion compared to those without any such history (3.2% [70,000] and 1.2% [830,000] children, respectively; odds ratio, 2.67; P < .001). Findings suggest a notable association between TBI and hearing loss. Children with a history of TBI are 2.67 times more likely to have concurrent hearing complaints.Level of Evidence: IV.
Collapse
Affiliation(s)
- Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Renata M Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Bhattacharyya
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Di Cesare T, Tricarico L, Passali GC, Sergi B, Paludetti G, Galli J, Picciotti PM. Traumatic benign paroxysmal positional vertigo: personal experience and comparison with idiopathic BPPV. Int J Audiol 2020; 60:393-397. [PMID: 32959692 DOI: 10.1080/14992027.2020.1821253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo, with post-traumatic origin in about 15% of cases. Management and prognosis of traumatic BPPV (T-BPPV) are still debated, especially about recurrence. The aim was to compare T-BPPV to idiopathic (I-BPPV). DESIGN AND STUDY SAMPLE We analysed data about 795 BPPV patients: 716 idiopathic (90%) and 79 post-traumatic (10%), evaluating clinical history and bedside-examination, treating all patients with repositioning manoeuvres and reassessing them until the resolution of symptoms and nystagmus. RESULTS Persistence rate in T-BPPV and I-BPPV patients was significantly different (p = 0.0074, OR = 2.31), respectively 12.6% and 5%. Also the rate of bilateral disease (p = 0.0063, OR = 4.72) and multicanalar involvement (p = 0.0183; OR = 4.67) were significantly higher in T-BPPV patients . There were no significant differences in age and sex distribution, side and canal interested. In T-BPPV group, the resolution rate with one manoeuvre was lower than I-BPPV (p = 0.0132: OR: 0,56). Recurrence rate was 38% in the T-BPPV group and 30.6% in the I-BPPV group, without significant difference. CONCLUSIONS T-BPPV resulted different from I-BPPV in the resolution rate, bilateral or multiple canal involvement and persistence rate. T-BPPV and I-BPPV does not differ for recurrence rate, suggesting that, after resolution, the natural course of post-traumatic and idiopathic BPPV is similar.
Collapse
Affiliation(s)
- Tiziana Di Cesare
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | - Laura Tricarico
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | | | - Bruno Sergi
- Otolaryngology, Catholic University, Rome, Italy
| | - Gaetano Paludetti
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
| | - Jacopo Galli
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
| | | |
Collapse
|
13
|
Gadre AK, Edwards IR, Baker VM, Roof CR. Membranous or Hypermobile Stapes Footplate: A New Anatomic Site Resulting in Third Window Syndrome. Front Neurol 2020; 11:871. [PMID: 32973657 PMCID: PMC7468399 DOI: 10.3389/fneur.2020.00871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives: To describe a potentially underappreciated pathology for post-traumatic persistent intractable dizziness and third window syndrome as well as the methods to diagnose and surgically manage this disorder. Study Design: Observational analytic case studies review at a tertiary care medical center. Methods: Patients suffering persistent dizziness following head trauma and demonstrating Tullio phenomena or Hennebert signs are included. All had reportedly normal otic capsules on high resolution temporal bone CT scans (CT). The gray-scale invert function was used to visualize the stapes footplate, which helped determine the diagnosis. Gray-scale inversion can be used to improve visualization of temporal bone anatomy and pathologic changes when diagnoses are in doubt. A search to check for the presence of perilymph leakage was performed in all cases. This was accomplished using intraoperative Valsalva maneuvers. Fat grafting of round and oval windows was performed. Results: Over an 11-year period between January 2009 and December 2019, 28 patients (33 ears) were treated. Follow-up with balance testing and audiograms were performed 6-8 weeks following surgery. Follow-up ranged from 6 months to 7 years. Prior to surgery all patients reported dizziness in response to loud sounds and/or barometric pressure changes. Seven out of 33 ears had demonstrable perilymph leakage into the middle ear; the rest (26 ears) appeared to have membranous or hypermobile stapes footplates. Membranous stapes footplates were better visualized using the invert function on CT. Thirteen patients had a fistula sign positive bilaterally while 15 had unilateral pathology. Twenty-four of the 28 patients (85.7%) showed both subjective and objective improvement following surgery. No patients suffered from a deterioration in hearing. Conclusions: A previously underappreciated membranous or hypermobile stapes footplate can occur following head trauma and can cause intractable dizziness typical of third window syndrome (TWS). Durable long term success can be achieved by utilizing fat graft patching of the round and oval windows. High resolution temporal bone CT scans using the gray-scale inversion (invert) function can assist in preoperative diagnosis.
Collapse
Affiliation(s)
- Arun K Gadre
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, United States
| | - Ingrid R Edwards
- Heuser Hearing Institute and Speech and Language Academy, Louisville, KY, United States
| | - Vicky M Baker
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, United States
| | - Casey R Roof
- Clinical Audiologist, Department of Otolaryngology-Head and Neck Surgery and Communication Sciences, University of Louisville, Louisville, KY, United States
| |
Collapse
|
14
|
Knoll RM, Lubner RJ, Brodsky JR, Wong K, Jung DH, Remenschneider AK, Herman SD, Kozin ED. Auditory Quality-of-Life Measures in Patients With Traumatic Brain Injury and Normal Pure Tone Audiometry. Otolaryngol Head Neck Surg 2020; 163:1250-1254. [PMID: 32600124 DOI: 10.1177/0194599820933886] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Auditory complaints are commonly reported following traumatic brain injury (TBI). However, few studies have examined patient-reported auditory symptomatology and quality-of-life metrics in individuals with TBI. We hypothesize that following TBI, individuals can experience auditory symptoms even with hearing thresholds in the normal range. Adult patients with normal auditory thresholds and a history of TBI were evaluated for subjective hearing loss, tinnitus, aural fullness, hyperacusis, and autophony. Hearing Handicap Inventory for Adults, Tinnitus Handicap Inventory, and Hyperacusis Questionnaire were administered. Thirty-one patients were prospectively recruited. Twenty-eight TBI participants (90%) reported ≥1 auditory symptoms at the time of survey intake. Mild to severe handicap in the Hearing Handicap Inventory for Adults and Tinnitus Handicap Inventory was reported in 71.4% and 40% of the participants with hearing loss and tinnitus, respectively. Hyperacusis handicap was considered significant in 41.1% of the participants who complained of hyperacusis and completed the survey. Despite normal hearing thresholds, individuals with TBI experience decrements in auditory quality-of-life metrics. Level of evidence: 3.
Collapse
Affiliation(s)
- Renata M Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rory J Lubner
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob R Brodsky
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin Wong
- Department of Otolaryngology, The Mount Sinai Hospital, New York, New York, USA
| | - David H Jung
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth D Herman
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Wang Y, Urioste RT, Wei Y, Wilder DM, Arun P, Sajja V, Gist ID, Fitzgerald TS, Chang W, Kelley MW, Long JB. Blast-induced hearing impairment in rats is associated with structural and molecular changes of the inner ear. Sci Rep 2020; 10:10652. [PMID: 32606369 PMCID: PMC7327022 DOI: 10.1038/s41598-020-67389-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
Auditory dysfunction is the most prevalent injury associated with blast overpressure exposure (BOP) in Warfighters and civilians, yet little is known about the underlying pathophysiological mechanisms. To gain insights into these injuries, an advanced blast simulator was used to expose rats to BOP and assessments were made to identify structural and molecular changes in the middle/inner ears utilizing otoscopy, RNA sequencing (RNA-seq), and histopathological analysis. Deficits persisting up to 1 month after blast exposure were observed in the distortion product otoacoustic emissions (DPOAEs) and the auditory brainstem responses (ABRs) across the entire range of tested frequencies (4–40 kHz). During the recovery phase at sub-acute time points, low frequency (e.g. 4–8 kHz) hearing improved relatively earlier than for high frequency (e.g. 32–40 kHz). Perforation of tympanic membranes and middle ear hemorrhage were observed at 1 and 7 days, and were restored by day 28 post-blast. A total of 1,158 differentially expressed genes (DEGs) were significantly altered in the cochlea on day 1 (40% up-regulated and 60% down-regulated), whereas only 49 DEGs were identified on day 28 (63% up-regulated and 37% down-regulated). Seven common DEGs were identified at both days 1 and 28 following blast, and are associated with inner ear mechanotransduction, cytoskeletal reorganization, myelin development and axon survival. Further studies on altered gene expression in the blast-injured rat cochlea may provide insights into new therapeutic targets and approaches to prevent or treat similar cases of blast-induced auditory damage in human subjects.
Collapse
Affiliation(s)
- Ying Wang
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA.
| | - Rodrigo T Urioste
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Yanling Wei
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Donna M Wilder
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Peethambaran Arun
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Venkatasivasaisujith Sajja
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Irene D Gist
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA
| | | | - Weise Chang
- Section on Developmental Neuroscience, National Institute on Deafness and Other Communication Disorders (NIDCD), Bethesda, MD, USA
| | - Matthew W Kelley
- Section on Developmental Neuroscience, National Institute on Deafness and Other Communication Disorders (NIDCD), Bethesda, MD, USA
| | - Joseph B Long
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Bethesda, MD, USA.
| |
Collapse
|
16
|
Lubner RJ, Knoll RM, Trakimas DR, Bartholomew RA, Lee DJ, Walters B, Nadol JB, Remenschneider AK, Kozin ED. Long-term cochlear implantation outcomes in patients following head injury. Laryngoscope Investig Otolaryngol 2020; 5:485-496. [PMID: 32596492 PMCID: PMC7314488 DOI: 10.1002/lio2.378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/27/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE In cases of a severe to profound sensorineural hearing loss following head injury, the cochlear implant (CI) is the primary option for auditory rehabilitation. Few studies, however, have investigated long-term CI outcomes in patients following head trauma, including those without temporal bone fracture (TBF). Herein, the aim of this study is to examine CI outcomes following cases of head injury with and without TBF. METHODS Audiometric outcomes of patients who received a CI due to a head injury resulting in severe to profound hearing loss at two tertiary care hospitals were analyzed. Patients were divided into those who received a CI in a fractured temporal bone (group A, n = 11 patients corresponding to 15 ears) and those who received a CI in a non-fractured temporal bone (group B, n = 8 patients corresponding to nine ears). Primary outcomes included duration of deafness prior to CI and postoperative consonant-nucleus-constant whole word (CNC) scores. RESULTS Nineteen patients (84% male), corresponding to 24 CIs, were identified. Fifteen CI were performed on ears with TBF (group A), and nine CI were performed on ears without TBF (group B). No patients had an enlarged vestibular aqueduct (EVA). The mean duration of deafness was 5.7 and 11.3 years in group A and group B, respectively. The mean duration of CI follow-up (CI experience) was 6.5 years in group A and 2.1 years in group B. The overall mean postoperative CNC score for all subjects was 68.6% (±21.2%, n = 19 with CNC testing). There was no difference in CNC score between group A and group B (69.8% and 66% respectively, P = .639). CONCLUSION The study is among the largest series examining long-term outcomes of CI after head injury. CI is an effective method for auditory rehabilitation in patients after head injury. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Rory J. Lubner
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Renata M. Knoll
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Danielle R. Trakimas
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyJohns Hopkins Medical SchoolBaltimoreMDUSA
| | - Ryan A. Bartholomew
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Daniel J. Lee
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Brad Walters
- Department of OtolaryngologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Joseph B. Nadol
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Aaron K. Remenschneider
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical CenterWorcesterMassachusettsUSA
| | - Elliott D. Kozin
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
17
|
Knoll RM, Ishai R, Lubner RJ, Trakimas DR, Brodsky JR, Jung DH, Rauch SD, Nadol JB, Remenschneider AK, Kozin ED. Peripheral Vestibular Organ Degeneration After Temporal Bone Fracture: A Human Otopathology Study. Laryngoscope 2019; 130:752-760. [PMID: 31074866 DOI: 10.1002/lary.28010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 03/28/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES/HYPOTHESIS Vestibular symptoms are a common sequela of temporal bone fractures (TBFs). The mechanisms of injury to the peripheral vestibular system following TBF, however, are not well described. Herein, we aimed to investigate the histopathology of the peripheral vestibular system in patients who sustained TBFs. STUDY DESIGN Retrospective human specimen analysis. METHODS Specimens from the National Temporal Bone Pathology Registry with (cases) and without (controls) TBFs were evaluated. Specimens were analyzed by light microscopy for vestibular hair cell and/or dendritic degeneration, presence of endolymphatic hydrops, blockage of the endolymphatic duct, and number of Scarpa ganglion cells (ScGCs) in the superior and inferior vestibular nerves. RESULTS Seven temporal bones (TBs) from five individuals with TBFs, and seven TBs from six age-matched individuals without a history of head injury met inclusion and exclusion criteria. All fractures involved the otic capsule. Severe degeneration of the cristae was identified in the semicircular canals in all TBF cases. The utricular and saccular maculae showed mild to severe degeneration in the TBF cases. Vestibular hydrops (n = 2 TBs) and blockage of the endolymphatic duct (n = 3 TBs) were also present in the TBF cases. There was a decrease of 52.6% in the mean total ScGC count in the TBF cases (n = 3 TBs) compared to age-matched controls (n = 7 TBs, P = .015). There was a mean loss of 53% of the ScGCs in the superior vestibular nerve and a mean loss of 52.3% of the ScGCs in the inferior vestibular nerve compared to age-matched controls (P = .033 and P = .021, respectively). CONCLUSIONS In a cohort of patients with TBFs, there were distinct peripheral vestibular changes including reduction of ScGCs. LEVEL OF EVIDENCE NA Laryngoscope, 130:752-760, 2020.
Collapse
Affiliation(s)
- Renata M Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Reuven Ishai
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Rory J Lubner
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Warren Alpert Medical School, Brown University, Providence, Rhode, Island
| | - Danielle R Trakimas
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - David H Jung
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Steven D Rauch
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Joseph B Nadol
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, U.S.A
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
18
|
Knoll RM, Herman SD, Lubner RJ, Babu AN, Wong K, Sethi RKV, Chen JX, Rauch SD, Remenschneider AK, Jung DH, Kozin ED. Patient‐reported auditory handicap measures following mild traumatic brain injury. Laryngoscope 2019; 130:761-767. [DOI: 10.1002/lary.28034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Renata M. Knoll
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
| | - Seth D. Herman
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation Hospital Boston Massachusetts
| | - Rory J. Lubner
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Warren Alpert Medical School of Brown University Providence Rhode Island
| | - Ashwin N. Babu
- Department of Sports MedicineMassachusetts General Hospital Boston Massachusetts
| | - Kevin Wong
- Department of Otolaryngology, Mount Sinai Medical Center New York New York
| | - Rosh K. V. Sethi
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
| | - Jenny X. Chen
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
| | - Steven D. Rauch
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
| | - Aaron K. Remenschneider
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation Hospital Boston Massachusetts
- Department of OtolaryngologyUniversity of Massachusetts Medical Center Worcester Massachusetts U.S.A
| | - David H. Jung
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
| | - Elliott D. Kozin
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
| |
Collapse
|
19
|
Tekin AM, Soylu E, Dizdar HT, Yılmaz F, Bayazit YA. Effects of Rhinoplasty on Labyrinthine Function. Aesthet Surg J 2018; 38:1172-1177. [PMID: 29757361 DOI: 10.1093/asj/sjy117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rhinoplasty is a common surgical procedure that is requested and accepted by patients for cosmetic and functional reasons. Osteotomies are performed on nasal bone, maxillary crest, or vomer to fix the deviations of the nasal dorsum or septum. During the percussion of the osteotomes with the surgical mallet, the vibration energy diffuses to the cranium. Auditory and vestibular systems may be affected by these vibrations. OBJECTIVES To assess the effects of rhinoplasty, in which osteotomies were performed using a hammer, on the audiovestibular system. METHODS Thirty adults who underwent rhinoplasty were included in the study group. Ten age and gender matched adults who had nasal surgery without surgical mallet or osteotome served as the control group. The patients in both groups were assessed using pure tone audiometry, tympanometry, distortion product otoacoustic emission testing, and vestibular-evoked myogenic potential, as well as video head impulse tests (vHIT) before the operation and 1 week after the operation. RESULTS On auditory assessment, there was no significant difference between the study and control groups regarding pure tone thresholds at frequencies of 250 Hz to 8 kHz (P > 0.05) as well as otoacoustic emissions. The vestibular assessment performed by using vestibular-evoked myogenic potential and vHIT did not reveal a statistically significant difference between the groups, before surgery or after surgery (P > 0.05). CONCLUSIONS Rhinoplasty appears to be a safe operation in terms of audiovestibular functions, and osteotomy, in which a hammer is usually used, does not have an impact on hearing or balance functions of the ear. LEVEL OF EVIDENCE 2
Collapse
Affiliation(s)
- Ahmet Mahmut Tekin
- Department of Otorhinolaryngology, Bilecik State Hospital, Bilecik, Turkey
| | - Erkan Soylu
- Department of Otorhinolaryngology, Istanbul Medipol University
| | | | | | | |
Collapse
|
20
|
Knoll RM, Ishai R, Trakimas DR, Chen JX, Nadol JB, Rauch SD, Remenschneider AK, Jung DH, Kozin ED. Peripheral Vestibular System Histopathologic Changes following Head Injury without Temporal Bone Fracture. Otolaryngol Head Neck Surg 2018; 160:122-130. [DOI: 10.1177/0194599818795695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective Vestibular symptoms such as dizziness and vertigo are common after head injury and may be due to trauma to the peripheral vestibular system. The pathophysiology of peripheral vestibular symptoms following head injury without temporal bone (TB) fracture, however, is not well understood. Herein, we investigate the histopathology of the peripheral vestibular system of patients who sustained head injury without a TB fracture. Study Design Otopathology study. Setting Otopathology laboratory. Subjects and Methods TB of subjects with a history of head injury without TB fractures were included and evaluated by light microscopy. Specimens were assessed for qualitative and quantitative characteristics, such as number of Scarpa’s ganglion cells in the superior and inferior vestibular nerves, vestibular hair cell and/or dendrite degeneration in vestibular end organs, presence of vestibular hydrops, and obstruction of the endolymphatic duct. Results Five cases (n = 5 TBs) had evidence of vestibular pathology. There was a decrease of 48.6% (range, 40%-59%) in the mean count of Scarpa’s ganglion cells as compared with that of normative historical age-matched controls. Moderate to severe degeneration of the vestibular membranous labyrinth was identified in the posterior, superior, and lateral canals in several cases (50%, n = 4 TBs). The maculae utriculi and sacculi showed mild to severe degeneration in 2 cases. Additional findings include vestibular hydrops (25%, n = 2 TBs) and blockage of the endolymphatic duct (n = 1 TB). Conclusions Otopathologic analysis of patients with a history of head injury without TB fracture demonstrated peripheral vestibular otopathology. Future studies are necessary to determine if otopathology findings are directly attributable to head injury.
Collapse
Affiliation(s)
- Renata M. Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Reuven Ishai
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Danielle R. Trakimas
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Jenny X. Chen
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph B. Nadol
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Steven D. Rauch
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Aaron K. Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - David H. Jung
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Elliott D. Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| |
Collapse
|
21
|
Ishai R, Knoll RM, Chen JX, Wong K, Reinshagen KL, Nadol JB, Remenschneider AK, Jung DH, Kozin ED. Otopathologic Changes in the Cochlea following Head Injury without Temporal Bone Fracture. Otolaryngol Head Neck Surg 2018; 159:526-534. [DOI: 10.1177/0194599818769861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Hearing loss following temporal bone (TB) fracture may result from direct transection of the middle and inner ear. The pathophysiology of hearing loss due to head injury without TB fracture, however, is not well understood. Few reports describe otopathologic findings. Herein, we investigate the pathologic findings of patients who sustained a head injury without evidence of a TB fracture. Study Design Otopathology study. Setting Otopathology laboratory. Subjects Subjects with a history of head injury without TB fracture. Methods The TBs of patients with head injury were evaluated by light microscopy. Inner ear anatomy was evaluated, including counts of spiral ganglion cells (SGCs), hair cells, pillar cells, atrophy of the stria vascularis, and the presence of endolymphatic hydrops. SGC counts were compared with those of historical age-matched controls. Results All cases (N = 6 TBs) had evidence of inner ear pathology. Of the 6 cases, 2 (33%) had severe loss of hair cells in all 3 turns of the cochlea, and 4 (67%) cases demonstrated moderate to severe loss at the basal turn of the cochlea. Four cases had scattered atrophy of the stria vascularis, and 3 (50%) had cochlear hydrops. The number of total SGCs was decreased, with an average 53% loss (range, 25%-79%) as compared with controls. The SGC count loss was evenly distributed along Rosenthal’s canal. Conclusions Patients with a history of head injury without TB fracture demonstrate inner ear pathology. Further studies are necessary to determine if otopathology findings are directly attributable to trauma.
Collapse
Affiliation(s)
- Reuven Ishai
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Renata M. Knoll
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jenny X. Chen
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Kevin Wong
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | | | - Joseph B. Nadol
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Aaron K. Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - David H. Jung
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Elliott D. Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Fortner MO, Oakley PA, Harrison DE. Alleviation of posttraumatic dizziness by restoration of the cervical lordosis: a CBP ® case study with a one year follow-up. J Phys Ther Sci 2018; 30:730-733. [PMID: 29765191 PMCID: PMC5940483 DOI: 10.1589/jpts.30.730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/19/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present the successful treatment of posttraumatic dizziness and neck pains
that were initiated in a patient following a whiplash event. [Subject and Methods] A
46 year old male suffered a whiplash event that initiated neck pain and dizziness
symptoms. The patient had many positive orthopedic findings and demonstrated a forward
head posture and cervical hypolordosis. The patient was treated by Chiropractic
BioPhysics® technique including cervical extension traction, extension
exercises and spinal manipulative therapy initially three times a week for 16-weeks, and
once a month thereafter. [Results] The patient had a resolution of daily dizziness and
neck pain with a concomitant reduction of forward head translation and increase in
cervical lordosis. The postural measures were further improved after one year of mostly
home-care. [Conclusion] The cervical spine alignment may be an important biomarker for
those with dizziness. The correction of cervical lordosis may be an essential requirement
for superior clinical outcomes for those with posttraumatic dizziness.
Collapse
|
23
|
Contralateral Cochlear Labyrinthine Concussion without Temporal Bone Fracture: Unusual Posttraumatic Consequence. Case Rep Otolaryngol 2016; 2016:2123182. [PMID: 27738540 PMCID: PMC5050347 DOI: 10.1155/2016/2123182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 01/23/2023] Open
Abstract
Introduction. Labyrinthine concussion is a term used to describe a rare cause of sensorineural hearing loss with or without vestibular symptoms occurring after head trauma. Isolated damage to the inner ear without involving the vestibular organ would be designated as a cochlear labyrinthine concussion. Hearing loss is not a rare finding in head trauma that involves petrous bone fractures. Nevertheless it generally occurs ipsilateral to the side of the head injury and extraordinarily in the contralateral side and moreover without the presence of a fracture. Case Report. The present case describes a 37-year-old patient with sensorineural hearing loss and tinnitus in his right ear after a blunt head trauma of the left-sided temporal bone (contralateral). Otoscopy and radiological images showed no fractures or any abnormalities. A severe sensorineural hearing loss was found in his right ear with a normal hearing of the left side. Conclusion. The temporal bone trauma requires a complete diagnostic battery which includes a neurotologic examination and a high resolution computed tomography scan in the first place. Hearing loss after a head injury extraordinarily occurs in the contralateral side of the trauma as what happened in our case. In addition, the absence of fractures makes this phenomenon even more unusual.
Collapse
|
24
|
Bertholon P, Chelikh L, Tringali S, Timoshenko A, Martin C. Combined Horizontal and Posterior Canal Benign Paroxysmal Positional Vertigo in Three Patients with Head Trauma. Ann Otol Rhinol Laryngol 2016; 114:105-10. [PMID: 15757188 DOI: 10.1177/000348940511400204] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report 3 patients who complained of positional vertigo shortly after head trauma. Positional maneuvers performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position with the head raised 30°) revealed a complex positional nystagmus that could only be interpreted as the result of combined PC and HC benign paroxysmal positional vertigo (BPPV). Two patients had a right PC BPPV and an ageotropic HC BPPV, and 1 patient had a bilateral PC BPPV and a left geotropic HC BPPV. All 3 patients were rapidly free of vertigo after the PC BPPV was cured by the Epley maneuver and the geotropic HC BPPV was cured by the Vannucchi method. The ageotropic HC BPPV resolved spontaneously. Neuroimaging (brain computed tomography and/or magnetic resonance imaging scans) findings were normal in all 3 patients. From a physiopathological viewpoint, it is easy to conceive that head trauma could throw otoconial debris into different canals of each labyrinth and be responsible for these combined forms of BPPV. Consequently, in trauma patients with vertigo, it is mandatory to perform the Dix-Hallpike maneuver, as well as supine lateral head turns, in order to diagnose PC BPPV, HC BPPV, or the association of both. Early diagnosis and treatment of BPPV may help to reduce the postconcussion syndrome.
Collapse
Affiliation(s)
- Pierre Bertholon
- Department of Otorhinolaryngology-Head and Neck Surgery, Bellevue Hospital, Saint-Etienne, France
| | | | | | | | | |
Collapse
|
25
|
Bogle JM, Barrs D, Wester M, Davis L, Cevette MJ. Labyrinthine concussion following gunshot injury: A case report. Int J Audiol 2016; 55:425-8. [PMID: 27092730 DOI: 10.3109/14992027.2016.1166398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Labyrinthine concussion due to a postauricular gunshot wound has not been well reported. DESIGN Retrospective chart review. STUDY SAMPLE We describe an otherwise healthy 22-year-old male who received a gunshot wound to the left mastoid and subsequently reported hearing loss and rotational vertigo. RESULTS Audiometric testing demonstrated significant inverted scoop shaped sensorineural hearing loss. Vestibular diagnostic testing indicated a significant uncompensated left peripheral vestibulopathy. Imaging demonstrated no structural changes to the middle ear or labyrinth, suggesting that the auditory and vestibular losses noted on diagnostic examination were likely due to labyrinthine concussion. CONCLUSIONS Labyrinthine concussion may lead to reduced vestibular reflex pathway following gunshot wounds to the temporal bone. Clinical presentation is likely to vary significantly among cases.
Collapse
Affiliation(s)
- Jamie M Bogle
- a Department of Otolaryngology , Mayo Clinic Arizona , Scottsdale , USA and
| | - David Barrs
- a Department of Otolaryngology , Mayo Clinic Arizona , Scottsdale , USA and
| | - Matthew Wester
- b Department of Audiology , Mayo Clinic Arizona , Scottsdale , USA
| | - Laurie Davis
- b Department of Audiology , Mayo Clinic Arizona , Scottsdale , USA
| | - Michael J Cevette
- a Department of Otolaryngology , Mayo Clinic Arizona , Scottsdale , USA and
| |
Collapse
|
26
|
Post traumatic deafness: a pictorial review of CT and MRI findings. Insights Imaging 2016; 7:341-50. [PMID: 27085885 PMCID: PMC4877355 DOI: 10.1007/s13244-016-0490-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Hearing loss is a common functional disorder after trauma, and radiologists should be aware of the ossicular, labyrinthine or brain lesions that may be responsible. After a trauma, use of a systematic approach to explore the main functional components of auditory pathways is essential. Conductive hearing loss is caused by the disruption of the conductive chain, which may be due to ossicular luxation or fracture. This pictorial review firstly describes the normal 2-D and 3-D anatomy of the ossicular chain, including the incudo-malleolar and incudo-stapedial joints. The role of 3-D CT in the post-traumatic evaluation of injury to the temporal bone is then evaluated. In the case of sensorineural hearing loss, CT can detect pneumolabyrinth and signs of perilymphatic fistulae but fails to detect subtle lesions within the inner ear, such as labyrinthine haemorrhage or localized brain axonal damage along central auditory pathways. The role that MRI with 3-D-FLAIR acquisition plays in the detection of inner ear haemorrhage and post-traumatic lesions of the brain parenchyma that may lead to auditory agnosia is also discussed. KEY POINTS • The most common middle ear injuries are incudo-malleolar and incudo-stapedial joint luxation. • In patients with SNHL, CT can detect pneumolabyrinth or perilymphatic fistula • 3-D-FLAIR MRI appears the best sequence to highlight labyrinthine haemorrhage • Axonal damage and brain hematoma may lead to deafness.
Collapse
|
27
|
Ramma L, Sebothoma B. The prevalence of hearing impairment within the Cape Town Metropolitan area. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2016; 63:105. [PMID: 27247255 PMCID: PMC5843235 DOI: 10.4102/sajcd.v63i1.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/21/2015] [Accepted: 03/20/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is a lack of data on the prevalence of hearing impairment in South Africa. Current data is unreliable as it is based on national census information which tends to underestimate the prevalence of hearing impairment. AIM The aim of this study was to estimate the prevalence of hearing impairment in the Cape Town Metropolitan area and to determine factors associated with hearing impairment. METHOD A cross-sectional household survey involving 2494 partcipants from 718 households was conducted between the months of February and October 2013. Random cluster sampling was used to select four health sub-districts from eight health sub-districts in the Cape Town Metropolitan area using a method of probability proportional to size (PPS). The survey was conducted according to the World Health Organization (WHO) Ear and Hearing Disorders Survey Protocol and the classifcation of hearing impairment matched the WHO's criteria for the grading of hearing impairment. RESULTS The overall prevalence of hearing impairment in the population of this study was 12.35% (95%CI: 11.06% - 13.64%) and prevalence of disabling hearing impairment was 4.57% (95% CI: 3.75% - 5.39%) amongst individuals ≥ 4 years old. The following factors were found to be associated with hearing impairment; male gender, age, hypertension, a history of head and neck trauma and a family history of hearing impairment. CONCLUSION Based on the data from communities surveyed during this study, hearing impairment is more prevalent than previously estimated based on national population census information. Interventions for the prevention of hearing impairment in these communities should focus on individuals with associated risk factors.
Collapse
Affiliation(s)
- Lebogang Ramma
- Division of Communication Sciences & Disorders, University of Cape Town.
| | | |
Collapse
|
28
|
Juliano AF, Ginat DT, Moonis G. Imaging Review of the Temporal Bone: Part II. Traumatic, Postoperative, and Noninflammatory Nonneoplastic Conditions. Radiology 2015; 276:655-72. [PMID: 26302389 DOI: 10.1148/radiol.2015140800] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The first part of this review of the temporal bone discussed anatomy of the temporal bone as well as inflammatory and neoplastic processes in the temporal bone region (1). This second part will first discuss trauma to the temporal bone and posttraumatic complications. The indications for common surgical procedures performed in the temporal bone and their postoperative imaging appearance are then presented. Finally, a few noninflammatory nonneoplastic entities involving the temporal bone are reviewed. They are relatively uncommon diagnoses compared with infectious or inflammatory diseases. However, because patients present with symptoms that are either common (hearing loss) or distinctive (sensorineural hearing loss in a child), they are important for the radiologist to be aware of and recognize.
Collapse
Affiliation(s)
- Amy F Juliano
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
| | - Daniel T Ginat
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
| | - Gul Moonis
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
| |
Collapse
|
29
|
Zhou G, Brodsky JR. Objective vestibular testing of children with dizziness and balance complaints following sports-related concussions. Otolaryngol Head Neck Surg 2015; 152:1133-9. [PMID: 25820582 DOI: 10.1177/0194599815576720] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/18/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To conduct objective assessment of children with balance and vestibular complaints following sports-related concussions and identify the underlying deficits by analyzing laboratory test outcomes. STUDY DESIGNS Case series with chart review. SETTING Pediatric tertiary care facility. SUBJECTS AND METHODS Medical records were reviewed of 42 pediatric patients with balance and/or vestibular complaints following sports-related concussions who underwent comprehensive laboratory testing on their balance and vestibular function. Patients' characteristics were summarized and results analyzed. RESULTS More than 90% of the children with protracted dizziness or imbalance following sports-related concussion had at least 1 abnormal finding from the comprehensive balance and vestibular evaluation. The most frequent deficit was found in dynamic visual acuity test, followed by Sensory Organization Test and rotational test. Patient's balance problem associated with concussion seemed to be primarily instigated by vestibular dysfunction. Furthermore, semicircular canal dysfunction was involved more often than dysfunction of otolith organs. Yet, <10% of the children experienced a hearing loss following sports-related concussion. CONCLUSIONS Vestibular impairment is common among children with protracted dizziness or imbalance following sports-related concussion. Our study demonstrated that proper and thorough evaluation is imperative to identify these underlying deficits and laboratory tests were helpful in the diagnosis and recommendation of following rehabilitations.
Collapse
Affiliation(s)
- Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Waltham, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Waltham, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
30
|
Krause MO, Kennedy MRT, Nelson PB. Masking release, processing speed and listening effort in adults with traumatic brain injury. Brain Inj 2014; 28:1473-84. [DOI: 10.3109/02699052.2014.920520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
An unusual case of sudden hearing loss in a young man. JAAPA 2013; 26:38-41. [PMID: 24049939 DOI: 10.1097/01.jaa.0000432572.44559.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute-onset hearing loss of unknown cause may be the result of a tranverse temporal bone fracture. CT imaging is indicated for patients with acute focal neurologic deficits of uncertain cause.
Collapse
|
32
|
Choi MS, Shin SO, Yeon JY, Choi YS, Kim J, Park SK. Clinical characteristics of labyrinthine concussion. KOREAN JOURNAL OF AUDIOLOGY 2013; 17:13-7. [PMID: 24653897 PMCID: PMC3936518 DOI: 10.7874/kja.2013.17.1.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/15/2013] [Accepted: 02/25/2013] [Indexed: 11/22/2022]
Abstract
Background and Objectives Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. Materials and Methods We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to 2007. We studied the hearing levels in each frequency and classified them according to type and degree of hearing loss. Rates of hearing improvement were evaluated according to age, sex, hearing loss type, degree and presence of dizziness or tinnitus. To find out any correlation between hearing improvement and these factors, we used χ2 test or Fisher's exact test. Results Bilateral hearing loss was observed in 22 patients, and unilateral hearing loss in 18 patients. There were 4 (6.5%) ascending, 34 (54.8%) descending, 24 (38.7%) flat type hearing loss, which indicated hearing loss was greater in high frequencies than low frequencies. Among 62 affected ears, 20 (32.3%) gained improvement, and it was achieved mainly in low frequencies. There were only 2 ears with dizziness in 20 improved ears and among 20 dizziness accompanied ears, also only 2 ears were improved. Conclusions High frequencies are more vulnerable to trauma than low frequencies. The hearing gain is obtained mainly in low frequencies, and association with dizziness serves poor prognosis.
Collapse
Affiliation(s)
- Mi Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - See-Ok Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Je Yeob Yeon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Young Seok Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jisung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| |
Collapse
|
33
|
Collins JM, Krishnamoorthy AK, Kubal WS, Johnson MH, Poon CS. Multidetector CT of Temporal Bone Fractures. Semin Ultrasound CT MR 2012; 33:418-31. [DOI: 10.1053/j.sult.2012.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
34
|
Ikezono T, Shindo S, Sekine K, Shiiba K, Matsuda H, Kusama K, Koizumi Y, Sugizaki K, Sekiguchi S, Kataoka R, Pawankar R, Baba S, Yagi T, Okubo K. Cochlin-tomoprotein (CTP) detection test identifies traumatic perilymphatic fistula due to penetrating middle ear injury. Acta Otolaryngol 2011; 131:937-44. [PMID: 21696257 DOI: 10.3109/00016489.2011.575795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONCLUSIONS The cochlin-tomoprotein (CTP) detection test can be used to make a definite, objective diagnosis of traumatic perilymphatic fistula (PLF), and therefore offers valuable information on patient selection for surgical treatment. OBJECTIVES Penetrating middle ear injury can cause traumatic PLF, which is a surgically treatable otologic emergency. Recently, we have reported on CTP, a novel perilymph-specific protein. The purpose of this study was to determine if the CTP detection test is useful for the diagnosis of traumatic PLF. METHODS This was a prospective study of CTP detection in penetrating middle ear injury cases with tympanic membrane perforation and hearing loss. RESULTS A total of seven individuals were included in this study. CTP was detected in three of four cases with posterosuperior quadrant perforation of the tympanic membrane. In one of these three cases, even though the high resolution CT scan was not suggestive of PLF and the perilymph leakage could not be visualized intraoperatively, the CTP detection test was able to detect PLF. In two cases, the preoperative positive test results enabled us to make a diagnosis of PLF and a decision for surgical treatment. CTP was not detected in the cases with anterior or inferior tympanic membrane perforation.
Collapse
Affiliation(s)
- Tetsuo Ikezono
- Department of Otorhinolaryngology, Nippon Medical School, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality? Am J Otolaryngol 2011; 32:376-80. [PMID: 20832902 DOI: 10.1016/j.amjoto.2010.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 07/17/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the true incidence, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this type of posttraumatic vertigo from other types of dizziness complained after trauma. METHODS This was a retrospective study comprising patients referred to our center after whiplash injury. The patients were evaluated with neurotologic examination including bedside and instrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients was submitted before and after treatment and was evaluated. The BPPV patients were separately evaluated from those with cervicogenic vertigo, and a comparison between our data about idiopathic BPPV was done. RESULTS Eighteen patients of whiplash who had BPPV were evaluated. The mean age was 38.2 years. BPPV was the cause of vertigo in 33.9% of total whiplash patients. In 16 cases, the posterior semicircular canal was involved; the lateral semicircular canal was involved in 2 cases. The instrumental neurotologic assessment did not show any alteration of either vestibulospinal reflexes or dynamic ocular movements. Duration of symptoms before treatment ranged from 3 to 26 days. A total of 55.5% of patients had relief from their symptoms after first repositioning maneuver. The Dizziness Handicap Inventory score improved in all patients treated with repositioning maneuvers, but no difference emerged with idiopathic BPPV data. CONCLUSION BPPV after whiplash injury could be unveiled with a simple bedside examination of peripheral vestibular system, and a treatment could be done in the same session. The diagnosis of posttraumatic BPPV is not different from the idiopathic form, but the treatment may require more maneuvers to achieve satisfactory results.
Collapse
|
36
|
Huang BY, Zdanski C, Castillo M. Pediatric sensorineural hearing loss, part 2: syndromic and acquired causes. AJNR Am J Neuroradiol 2011; 33:399-406. [PMID: 21596810 DOI: 10.3174/ajnr.a2499] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article is the second in a 2-part series reviewing neuroimaging in childhood SNHL. Previously, we discussed the clinical work-up of children with hearing impairment, the classification of inner ear malformations, and congenital nonsyndromic causes of hearing loss. Here, we review and illustrate the most common syndromic hereditary and acquired causes of childhood SNHL, with an emphasis on entities that demonstrate inner ear abnormalities on cross-sectional imaging. Syndromes discussed include BOR syndrome, CHARGE syndrome, Pendred syndrome, Waardenburg syndrome, and X-linked hearing loss with stapes gusher. We conclude the article with a review of acquired causes of childhood SNHL, including infections, trauma, and neoplasms.
Collapse
Affiliation(s)
- B Y Huang
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | | | | |
Collapse
|
37
|
Lee JD, Park MK, Lee BD, Park JY, Lee TK, Sung KB. Otolith function in patients with head trauma. Eur Arch Otorhinolaryngol 2011; 268:1427-30. [DOI: 10.1007/s00405-010-1426-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
|
38
|
Clinical Characteristics and Treatment of Benign Paroxysmal Positional Vertigo After Traumatic Brain Injury. ACTA ACUST UNITED AC 2011; 70:442-6. [DOI: 10.1097/ta.0b013e3181d0c3d9] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Dispenza F, Gargano R, Mathur N, Saraniti C, Gallina S. Analysis of visually guided eye movements in subjects after whiplash injury. Auris Nasus Larynx 2010; 38:185-9. [PMID: 20971586 DOI: 10.1016/j.anl.2010.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 08/24/2010] [Accepted: 08/25/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aims of present research were to analyze the visually guided eye movements of subjects suffering from the consequences of whiplash injury and the possibility to differentiate patients from feigning subject. We analyzed the role of video-nystagmography for clinical and forensic aspects. METHODS It was a prospective case-control study. Detailed history was taken and patients were thoroughly investigated. Smooth pursuit and saccadic eye movements were assessed in 33 patients affected by imbalance following a whiplash injury. A control group of 20 subjects was also evaluated. All tests were executed in neutral neck position and after left and right trunk rotation. RESULTS The t-test, applied to all parameters showed that difference of the parameter between the groups was not statistically significant. CONCLUSION The visually guided eye movement evaluation does not seem to offer a clinically relevant method to differentiate patients suffering from the effects of whiplash injury from normal subjects.
Collapse
Affiliation(s)
- Francesco Dispenza
- Dipartimento Discipline Chirurgiche e Oncologiche - U.O. Otorinolaringoiatria, Università degli Studi di Palermo, Italy.
| | | | | | | | | |
Collapse
|
40
|
Abstract
BACKGROUND Damage to the peripheral auditory structures has long been recognized as a common component of head injury. It is estimated that a majority of patients with skull trauma have resultant hearing impairment. Damage to the peripheral and/or central auditory pathways can occur as a primary or secondary injury. Considering the high incidence of hearing loss, it was considered worthwhile to conduct an in-depth investigation by administering a comprehensive audiological test battery on head-injured patients. METHOD The sample population consisted of 290 subjects with closed head injury (study group) and 50 subjects with otologically normal subjects (control group). The subjects in the study group were further divided into mild (n = 150), moderate (n = 100), and severe (n = 40) category on the basis of Glasgow Coma Scale score. The audiological assessment consisted of pure tone audiometry, speech audiometry, tympanometry, acoustic reflex testing, auditory brain stem response audiometry, and middle latency response audiometry. RESULTS AND CONCLUSIONS It is concluded that there is higher prevalence of hearing impairment in the study group compared with control group. Majority of the patients who incur hearing loss after closed head injury have mild degree of hearing impairment. A significant difference between the study and control group observed on majority of the auditory brain stem response and middle latency response parameters studied.
Collapse
|
41
|
Abstract
The purpose of this study was to assess the results of a hearing evaluation protocol among 130 pediatric patients with a head injury. Sixteen of these patients failed an audiology evaluation. Ten were thought to have failed based on congestion/middle ear dysfunction, while 6 patients had temporary or permanent hearing loss thought to be related to their injury. The majority who failed because of their injury had temporal bone fractures and abnormal visual ear examination results. More research on trauma-related hearing loss following various types of head injuries and skull fractures in pediatric patients of varying ages is needed.
Collapse
|
42
|
Atkin G, Watkins L, Rich P. Bilateral sensorineural hearing loss complicating basal skull fracture. Br J Neurosurg 2009. [DOI: 10.1080/02688690209168368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
43
|
Maskell F, Chiarelli P, Isles R. Dizziness after traumatic brain injury: Results from an interview study. Brain Inj 2009; 21:741-52. [PMID: 17653948 DOI: 10.1080/02699050701472109] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dizziness is a commonly reported sequel to traumatic brain injury (TBI). OBJECTIVE To better define the nature of the symptomatology and the impact that dizziness has on the TBI survivor. SETTING A community brain injury rehabilitation programme and a community access programme for TBI survivors. METHOD Focus groups with TBI survivors and individual interviews with TBI survivors and some of their carers. RESULTS The data confirmed that dizziness is difficult for TBI survivors to define and describe and it consists of multiple symptoms. Dizziness also appears to be associated with significant functional difficulties. Additionally, many of the participants of this study reported falling. Carers reported a number of observable signs of dizziness and indicated that they believed they were able to tell when the person they cared for was dizzy. CONCLUSION The results provide information which will help in the development of more appropriate outcome measurement tools for dizziness after a TBI.
Collapse
Affiliation(s)
- Fiona Maskell
- Discipline of Physiotherapy, Faculty of Health, School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia.
| | | | | |
Collapse
|
44
|
Maskell F, Chiarelli P, Isles R. Dizziness after traumatic brain injury: Overview and measurement in the clinical setting. Brain Inj 2009; 20:293-305. [PMID: 16537271 DOI: 10.1080/02699050500488041] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Traumatic brain injury (TBI) may result in a variety of cognitive, behavioural and physical impairments. Dizziness has been reported in up to 80% of cases within the first few days after injury. The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. The literature provides widely differing estimates of prevalence and vestibular system dysfunction appears to be the best reported of impairments contributing to this symptom. The variety of results is discussed and other possible causes for dizziness were reviewed. Functional difficulties caused by dizziness were not reported for this population in the literature and review of cognitive impairments suggests that existing measurement tools for dizziness may be problematic in this population. Research on the functional impact of dizziness in the TBI population and measurement of these symptoms appears to be warranted.
Collapse
|
45
|
Penn C, Watermeyer J, Schie K. Auditory disorders in a South African paediatric TBI population: some preliminary data. Int J Audiol 2009; 48:135-43. [PMID: 19283585 DOI: 10.1080/14992020802635309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
South Africa has an exceptionally high incidence of traumatic brain injury in its paediatric population but very little systematic research has been conducted on the outcome of such injury. A number of socio demographic variables influence the mechanism of injury as well as its management. This paper reports on a study documenting the educational and audiological outcomes of a group of 100 subjects who sustained their injuries prior to the age of 12 years. The hearing and communication profile of this group is considered in relation to educational outcome. An illustrative case study will demonstrate the multiple influences on outcome in this setting, as well as the need for integrated team management. In the sample, 31% had a reported hearing loss, confirmed audiologically in 14% of subjects. The majority of the sample returned to a mainstream school. However, analysis indicated that about 75% of the sample was in need of specialized education, while only 22% of that sample had received any additional support. The implications of these findings for audiological policy and practice are highlighted.
Collapse
Affiliation(s)
- Claire Penn
- Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg, South Africa.
| | | | | |
Collapse
|
46
|
|
47
|
Tranter RMD, Graham JR. A review of the otological aspects of whiplash injury. J Forensic Leg Med 2008; 16:53-5. [PMID: 19134996 DOI: 10.1016/j.jflm.2008.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 09/06/2008] [Indexed: 11/24/2022]
Abstract
Approximately 10% of patients who have suffered with whiplash injury will develop otological symptoms such as tinnitus, deafness and vertigo. Some of these are purely subjective symptoms; nevertheless, for the majority there are specific tests that can be undertaken. These tests can quantify the extent and severity of the symptoms as well as provide guidance as to the correct rehabilitation pathway. This article reviews the body of literature relating to the otological aspects of whiplash injury and gives an overview for medical and legal professionals.
Collapse
Affiliation(s)
- R M D Tranter
- ENT Department, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Lewes Road, Haywards Heath, West Sussex RH16 4EX, United Kingdom.
| | | |
Collapse
|
48
|
Van Eyken E, Van Camp G, Van Laer L. The complexity of age-related hearing impairment: contributing environmental and genetic factors. Audiol Neurootol 2007; 12:345-58. [PMID: 17664866 DOI: 10.1159/000106478] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 05/18/2007] [Indexed: 12/24/2022] Open
Abstract
Age-related hearing impairment (ARHI) is the most common sensory impairment seen in the elderly. It is a complex disorder, with both environmental as well as genetic factors contributing to the impairment. The involvement of several environmental factors has been partially elucidated. A first step towards the identification of the genetic factors has been made, which will result in the identification of susceptibility genes, and will provide possible targets for the future treatment and/or prevention of ARHI. This paper aims to give a broad overview of the scientific findings related to ARHI, focusing mainly on environmental and genetic data in humans and in animal models. In addition, methods for the identification of contributing genetic factors as well as possible future therapeutic strategies are discussed.
Collapse
Affiliation(s)
- E Van Eyken
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | | | | |
Collapse
|
49
|
Graziano DL, Nitsch W, Huijbregts PA. Positive cervical artery testing in a patient with chronic whiplash syndrome: clinical decision-making in the presence of diagnostic uncertainty. J Man Manip Ther 2007; 15:E45-63. [PMID: 19066653 PMCID: PMC2565616 DOI: 10.1179/jmt.2007.15.3.45e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This case report describes the diagnosis and management of a 43-year-old female patient who had sustained an injury to her neck in a motor-vehicle accident two years earlier. The major symptoms described by the patient included headache and neck pain, but history and examination also revealed signs and symptoms potentially indicative of cervical artery compromise. Physical therapy management initially consisted of soft tissue and non-thrust joint manipulation of the lower cervical and thoracic spine, specific exercise prescription, and superficial heat. Cervical vascular compromise was re-evaluated by way of the sustained extension-rotation test. When at the fifth visit this test no longer produced symptoms potentially indicative of vascular compromise, upper cervical diagnosis and management consisting of soft tissue and non-thrust joint manipulation was added. A positive outcome was achieved both at the impairment level and with regard to limitations in activities, the latter including increased performance at work, a return to previous reading activities, improved length and quality of sleep, and greater comfort while driving. At discharge, the patient reported only occasional pain and mild limitations in activities. This report describes the positive outcomes in a patient with chronic whiplash syndrome; however, its main emphasis lies in the discussion and critical evaluation of clinical reasoning in the presence of diagnostic uncertainty with regard to cervical artery compromise.
Collapse
|
50
|
Ernst A, Basta D, Seidl RO, Todt I, Scherer H, Clarke A. Management of posttraumatic vertigo. Otolaryngol Head Neck Surg 2005; 132:554-8. [PMID: 15806044 DOI: 10.1016/j.otohns.2004.09.034] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate patients after blunt trauma of the head, neck, and craniocervical junction (without fractures) with vertigo and to report the results of treatment after extensive diagnostics. STUDY DESIGN Prospective study of consecutive new cases with vertigo after trauma at different periods of onset. During 2000-2002, 63 patients were examined and treated. SETTING Regional trauma medical center for the greater Berlin Area, tertiary referral unit. RESULTS The primary disorders included labyrinthine concussion (18), rupture of the round window membrane (6), and cervicogenic vertigo (12). The secondary disorders included otolith disorders (5), delayed endolymphatic hydrops (12), and canalolithiasis (9). The patients were free of vertigo symptoms (except cervicogenic and otolith disorder) after treatment, which consisted of habituation training, medical and surgical therapy options. The follow-up was 1 year. CONCLUSION Posttraumatic vertigo can be treated with a high success rate once the underlying disorder has been identified. The extent of the neurotological test battery determines the precision and quality of diagnostics. Surgical measures should be an integral part of treatment modalities if conservative treatment is not effective. SIGNIFICANCE Minor trauma of the head, neck, and craniocervical junction can have major impact on the vestibular system at different sites. Patients need to be carefully diagnosed, even if the onset of vertigo occurs a few weeks or months after the initial trauma.
Collapse
Affiliation(s)
- Arne Ernst
- Department of Otolaryngology at ukb Medical Center, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|