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Kumar S, Dutta A, Marlapudi SK. Temporal Bone Fractures after Trauma: A Prospective Analysis of Presentation, Management, and Outcomes. Indian J Otolaryngol Head Neck Surg 2024; 76:2367-2372. [PMID: 38883469 PMCID: PMC11169185 DOI: 10.1007/s12070-024-04519-9] [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: 11/20/2023] [Accepted: 01/08/2024] [Indexed: 06/18/2024] Open
Abstract
To comprehensively understand the manifestation, treatments, and resultant consequences of temporal bone fractures, given their substantial impact on auditory and balance systems and the overall quality of life. A prospective study, adhering to the STROBE guidelines, spanning five years (2011-2015) was conducted on 83 male patients aged between 20 and 54 years, diagnosed with temporal bone fractures primarily caused by road traffic accidents. Evaluations comprised symptom presentation, otologic manifestations, radiological classifications, and management strategies, including both conservative and surgical interventions. Our study found that patients commonly presented with symptoms such as Oto-haematorrhoea, hearing impairment, and vertigo. Specifically, longitudinal fractures were the most frequent radiological finding, occurring in 63 cases (p < 0.001 for road traffic accidents). In terms of treatment outcomes, there was a notable improvement in the average hearing threshold, decreasing from 50 dB to 25 dB post-treatment (p < 0.001), and the air-bone gap reduced from 30 dB to 10 dB (p < 0.001). Audiometric outcomes varied significantly with fracture type, showing severe hearing loss was more common in transverse fractures (50%, p < 0.001) compared to longitudinal and mixed fractures. Additionally, the study revealed a significant reduction in the incidence of post-trauma vertigo over eight weeks (p < 0.001), underscoring the importance of early and appropriate intervention in managing temporal bone fractures. Efficient early detection and tailored interventions for temporal bone fractures lead to optimistic results. This research underscores the imperative for healthcare practitioners to adopt a comprehensive approach, from initial diagnosis to ongoing monitoring, to achieve optimal patient care. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-024-04519-9.
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Affiliation(s)
- Sanjay Kumar
- Department of ENT, HOD, Trained in Head & Neck Surgery, Command Hospital Airforce Bangalore, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Angshuman Dutta
- Department of ENT, HOD, Trained in Head & Neck Surgery, Command Hospital Airforce Bangalore, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Sudheer Kumar Marlapudi
- Department of ENT, HOD, Trained in Head & Neck Surgery, Command Hospital Airforce Bangalore, Rajiv Gandhi University of Health Sciences, Bangalore, India
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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.
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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
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Chae R, Barber J, Temkin NR, Sharon JD. Dizziness After Traumatic Brain Injury: A Prospective TRACK-TBI Analysis of Risk Factors, Quality of Life, and Neurocognitive Effects. Otol Neurotol 2022; 43:e1148-e1156. [PMID: 36201561 DOI: 10.1097/mao.0000000000003710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the longitudinal incidence of dizziness and its association with demographic factors, neurocognitive effects, functionality, and quality of life. STUDY DESIGN Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) is a prospective, longitudinal cohort study in which TBI patients were assessed at the emergency department and 2-week, 3-month, 6-month, and 12-month follow-up via telephone and/or in-person visits. SETTING Multicenter study in emergency departments of 18 academic medical centers in the United States. PATIENTS A total of 1,514 patients 17 years or older with a diagnosis of TBI, injury occurrence within 24 hours of admission, fluency in English or Spanish, and completed Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 12 months were enrolled between February 2014 and August 2018. MAIN OUTCOME MEASURE RPQ, Short Form-12 Version 2, Wechsler Adult Intelligence Scale IV, Trail Making Test, Patient Health Questionnaire-9, PROMIS-PAIN, and Glasgow Outcome Scale-Extended Revised. The primary outcome measure was a self-report of "feelings of dizziness" on RPQ at 12 months post-TBI. RESULTS Of the 1,514 participants, 1,002 (66%) were male and 512 (34%) were female. The mean age was 41.6 (SD, 17.4) years. At 12 months, 26% experienced dizziness, with 9% experiencing moderate or severe dizziness. Dizziness was strongly associated with headache (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.92-4.07; p < 0.001), nausea (OR, 4.43; 95% CI, 3.45-5.69; p < 0.001), worse hearing (OR, 3.57; 95% CI, 2.64-4.82; p < 0.001), noise sensitivity (OR, 3.02; 95% CI, 2.54-3.59; p < 0.001), and light sensitivity (OR, 3.51; 95% CI, 2.91-4.23; p < 0.001). In multivariable regression models, participants with severe dizziness demonstrated lower performance compared with those without new or worse dizziness on the Wechsler Adult Intelligence Scale IV (-6.64; p < 0.001), Trail Making Test part A (7.90; p = 0.003) and part B (19.77; p = 0.028), and Short Form-12 physical (-13.60; p < 0.001) and mental health (-11.17; p < 0.001), after controlling for age, sex, education, and TBI severity. CONCLUSION Dizziness is common among TBI patients and relates to quality of life and neurocognitive performance.
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Affiliation(s)
- Ricky Chae
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | | | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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Taylor RL, Wise KJ, Taylor D, Chaudhary S, Thorne PR. Patterns of vestibular dysfunction in chronic traumatic brain injury. Front Neurol 2022; 13:942349. [DOI: 10.3389/fneur.2022.942349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022] Open
Abstract
BackgroundDizziness and imbalance are common following traumatic brain injury (TBI). While these symptoms are often attributed to vestibular dysfunction, the relative contribution of peripheral vs. central mechanisms is unclear. This study investigated the prevalence of semicircular canal and otolith abnormalities in a cohort of patients with chronic TBI and symptoms of dizziness or imbalance. The relationship between vestibular, oculomotor and posturography results was further explored.MethodsClinical records of patients attending the New Zealand Dizziness and Balance Centre from January 2015 to December 2019 were reviewed for consideration in the study. Inclusion required: an age of 18–80 years, a diagnosed TBI, and vestibular assessment using three-dimensional video head impulses (vHIT), cervical and ocular vestibular-evoked myogenic potentials (c and o VEMPs, respectively) and caloric testing. Severe TBI, pre-existing vestibular diagnoses, and incomplete test results were excluded. Rates of abnormalities were determined for each test and compared with results of oculomotor function testing and postural control, measured using the sensory organization test (SOT).ResultsOf 158 reviewed records, 99 patients aged 49 ± 15 years (59 female) fulfilled criteria for inclusion in the study. The median time between the head injury and the clinical assessment was 12 (IQR 6–21) months. Abnormalities involving one or more components of the vestibular labyrinth and/or nerve divisions were identified in 33 of 99 patients (33.3%). The horizontal semicircular canal was most frequently affected (18.2%), followed by the saccule (14.1%), utricle (8.1%), posterior (7.1%) and anterior (2.0%) semicircular canals. Vestibular test abnormalities were associated with skull-base fractures, superior canal dehiscence, and focal ear trauma. Oculomotor dysfunction and postural instability were recorded in 41.1 and 75.5% of patients, respectively. Postural instability correlated with abnormal oculomotor function (p = 0.008) but not peripheral vestibular hypofunction (p = 0.336).ConclusionsDizziness and/or imbalance in chronic TBI was associated with impaired postural stability for tasks requiring high levels of use of vestibular and visual input for balance. Vestibular hypofunction identified through vHIT, VEMP and caloric testing was recorded but was less common, except when the injury involved a fractured skull-base. There was no specific pattern of end-organ or nerve involvement which characterized this group of patients.
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Gard A, Al-Husseini A, Kornaropoulos EN, De Maio A, Tegner Y, Björkman-Burtscher I, Markenroth Bloch K, Nilsson M, Magnusson M, Marklund N. Post-Concussive Vestibular Dysfunction Is Related to Injury to the Inferior Vestibular Nerve. J Neurotrauma 2022; 39:829-840. [PMID: 35171721 PMCID: PMC9225415 DOI: 10.1089/neu.2021.0447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Symptoms of vestibular dysfunction such as dizziness and vertigo are common after sports-related concussions (SRC) and associated with a worse outcome and a prolonged recovery. Vestibular dysfunction after SRC can be because of an impairment of the peripheral or central neural parts of the vestibular system. The aim of the present study was to establish the cause of vestibular impairment in athletes with SRC who have persisting post-concussive symptoms (PPCS). We recruited 42 participants-21 athletes with previous SRCs and PPCS ≥6 months and 21 healthy athletic age- and sex-matched controls-who underwent symptom rating, a detailed test battery of vestibular function and 7T magnetic resonance imaging with diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) of cerebellar white matter tracts, and T1-weighted imaging for cerebellar volumetrics. Vestibular dysfunction was observed in 13 SRC athletes and three controls (p = 0.001). Athletes with vestibular dysfunction reported more pronounced symptoms on the Dizziness Handicap Inventory (DHI; p < 0.001) and the Hospital Anxiety and Depression Scale (HADS; p < 0.001). No significant differences in DTI metrics were found, while in DKI two metrics were observed in the superior and/or inferior cerebellar tracts. Cerebellar gray and white matter volumes were similar in athletes with SRC and controls. Compared with controls, pathological video head impulse test results (vHIT; p < 0.001) and cervical vestibular evoked myogenic potentials (cVEMP; p = 0.002) were observed in athletes with SRC, indicating peripheral vestibular dysfunction and specifically suggesting injury to the inferior vestibular nerve. In athletes with persisting symptoms after SRC, vestibular dysfunction is associated with injury to the inferior vestibular nerve.
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Affiliation(s)
- Anna Gard
- Department of Clinical Sciences Lund, Lund University, Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Ali Al-Husseini
- Department of Clinical Sciences Lund, Lund University, Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Evgenios N. Kornaropoulos
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Alessandro De Maio
- Department of Radiological, Oncological and Pathological Sciences. Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Isabella Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Markus Nilsson
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Måns Magnusson
- Department of Clinical Sciences Lund, Otorhinolaryngology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Lund University, Neurosurgery, Skåne University Hospital, Lund, Sweden
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Gianoli GJ. Post-concussive Dizziness: A Review and Clinical Approach to the Patient. Front Neurol 2022; 12:718318. [PMID: 35058868 PMCID: PMC8764304 DOI: 10.3389/fneur.2021.718318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/13/2021] [Indexed: 01/25/2023] Open
Abstract
Dizziness is a frequent complaint after head trauma. Among patients who suffer a concussion (mild traumatic brain injury or mTBI), dizziness is second only to headache in symptom frequency. The differential diagnosis of post-concussive dizziness (PCD) can be divided into non-vestibular, central vestibular and peripheral vestibular causes with growing recognition that patients frequently exhibit both central and peripheral findings on vestibular testing. Symptoms that traditionally have been ascribed to central vestibular dysfunction may be due to peripheral dysfunction. Further, our ability to test peripheral vestibular function has improved and has allowed us to identify peripheral disorders that in the past would have remained unnoticed. The importance of the identification of the peripheral component in PCD lies in our ability to remedy the peripheral vestibular component to a much greater extent than the central component. Unfortunately, many patients are not adequately evaluated for vestibular disorders until long after the onset of their symptoms. Among the diagnoses seen as causes for PCD are (1) Central vestibular disorders, (2) Benign Paroxysmal Positional Vertigo (BPPV), (3) Labyrinthine dehiscence/perilymph fistula syndrome, (4) labyrinthine concussion, (5) secondary endolymphatic hydrops, (6) Temporal bone fracture, and (7) Malingering (particularly when litigation is pending). These diagnoses are not mutually exclusive and PCD patients frequently exhibit a combination of these disorders. A review of the literature and a general approach to the patient with post-concussive dizziness will be detailed as well as a review of the above-mentioned diagnostic categories.
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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Jafarzadeh S, Pourbakht A, Bahrami E. Vestibular Assessment in Patients with Persistent Symptoms of Mild Traumatic Brain Injury. Indian J Otolaryngol Head Neck Surg 2020; 74:272-280. [PMID: 36032895 PMCID: PMC9411379 DOI: 10.1007/s12070-020-02043-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/08/2020] [Indexed: 12/26/2022] Open
Abstract
Aim The estimated worldwide incidence of TBI is 10 million cases per year. Dizziness and imbalance are two common symptoms in mild TBI (mTBI). In about 10-15% of TBI patients, these symptoms remain for a long time and may show no recovery. These persistent symptoms may relate to different factors including vestibular abnormalities. The aim of this study is a vestibular assessment of patients with persistent symptoms of mTBI by different tests including computerized dynamic posturography. Materials and Methods 21 patients with mTBI evaluated in this study. Patients were civilians with persistent symptoms. TBI did cause by blunt force trauma (mainly from falling) in the past 6 months. They had normal neurologic and musculoskeletal assessments and no temporal bone fracture. Several auditory and vestibular evaluations were performed for each patient. They included: case history, otoscopy, pure tone and speech audiometry, tympanometry, vestibular bedside examination (spontaneous nystagmus, gaze, saccade, pursuit, Dix-Hallpike maneuver, side-lying maneuver, roll, and Romberg test), cervical Vestibular Myogenic Evoked Potential (c-VEMP), Computerized Dynamic Posturography (CDP) and Dizziness Handicap Inventory (DHI). Results Patients showed hearing loss in 10 (47.6%) and tinnitus in 4 (19.0%) cases. In ocular motor tests, patients had the most abnormal results in the pursuit test. 6 patients also had Benign Paroxysmal Positional Vertigo (BPPV) in the posterior canal. c-VEMP showed abnormal saccular function in 14 patients. In CDP, the composite scores were decreased relative to normal populations. Conclusion vestibular tests showed abnormal results in most patients. Vestibular abnormality could relate to persisting symptoms of mTBI patients.
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Pauna HF, Knoll RM, Lubner RJ, Brodsky JR, Cushing SL, Hyppolito MA, Nadol JB, Remenschneider AK, Kozin ED. Histopathological changes to the peripheral vestibular system following meningitic labyrinthitis. Laryngoscope Investig Otolaryngol 2020; 5:256-266. [PMID: 32337357 PMCID: PMC7178454 DOI: 10.1002/lio2.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE While cochlear ossification is a common sequalae of meningitic labyrinthitis, less is known about the effects of meningitis on peripheral vestibular end organs. Herein, we investigate histopathologic changes in the peripheral vestibular system and cochlea in patients with a history of meningitic labyrinthitis. METHODS Temporal bone (TB) specimens from patients with a history of meningitis were evaluated and compared to age-matched controls. Specimens were evaluated by light microscopy and assessed for qualitative changes, including the presence of vestibular and/or cochlear endolymphatic hydrops, presence and location of inflammatory cells, new bone formation, and labyrinthitis ossificans; and quantitative changes, including Scarpa's ganglion neuron (ScGN) and spiral ganglion neuron (SGN) counts. RESULTS Fifteen TB from 10 individuals met inclusion and exclusion criteria. Presence of inflammatory cells and fibrous tissue was found in 5 TB. Of these, evidence of labyrinthitis ossificans was found in 2 TB. In the peripheral vestibular system, mild to severe degeneration of the vestibular membranous labyrinth was identified in 60% of cases (n = 9 TBs). There was a 21.2% decrease (range, 3%-64%) in the mean total count of ScGN in patients with meningitis, compared to age-matched controls. In the cochlea, there was a 45% decrease (range, 25.3%-80.9%) in the mean total count of SGN compared to age-matched controls (n = 14 TBs). CONCLUSIONS Otopathologic analysis of TB from patients with a history of meningitic labyrinthitis demonstrated distinct peripheral vestibular changes. Future research may help to delineate potential mechanisms for the observed otopathologic changes following meningitis. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Henrique F. Pauna
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck SurgeryRibeirão Preto Medical School (FMRP‐USP), University of São PauloRibeirão PretoSão PauloBrazil
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
| | - Renata M. Knoll
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Rory J. Lubner
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Jacob R. Brodsky
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusetts
| | - Sharon L. Cushing
- Department of Otolaryngology, Head & Neck SurgeryHospital for Sick Children, University of TorontoTorontoOntarioCanada
| | - Miguel A. Hyppolito
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck SurgeryRibeirão Preto Medical School (FMRP‐USP), University of São PauloRibeirão PretoSão PauloBrazil
| | - Joseph B. Nadol
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Aaron K. Remenschneider
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Elliott D. Kozin
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Otopathology Laboratory, Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusetts
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusetts
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Krouse JH. Highlights from the Current Issue: January 2019. Otolaryngol Head Neck Surg 2019; 160:6-7. [PMID: 30798738 DOI: 10.1177/0194599818815805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John H Krouse
- 1 School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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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.
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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
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Grafton ST, Ralston AB, Ralston JD. Monitoring of postural sway with a head-mounted wearable device: effects of gender, participant state, and concussion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:151-164. [PMID: 31118838 PMCID: PMC6503189 DOI: 10.2147/mder.s205357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess the utility of a head-mounted wearable inertial motion unit (IMU)-based sensor and 3 proposed measures of postural sway to detect outliers in athletic populations at risk of balance impairments. Methods: Descriptive statistics are used to define a normative reference range of postural sway (eyes open and eyes closed) in a cross-sectional sample of 347 college students using a wireless head-mounted IMU-based sensor. Three measures of postural sway were derived: linear sway power, eyes closed vs eyes open sway power ratio (Ec/Eo ratio), and weight-bearing asymmetry (L-R ratio), and confidence intervals for these measures were calculated. Questionnaires were used to identify potentially confounding state variables. A prospective study of postural sway changes in 47 professional, college, and high school athletes was then carried out in on-field settings to provide estimates of session-to-session variability and the influence of routine physical activity on sway measures. Finally, pre-post-injury changes in sway are measured for a participant who was diagnosed with a concussion. Results: Despite the heterogenous population and sampling environments, well-defined confidence intervals were established for all 3 sway measures. Men demonstrated significantly greater sway than women. Two state variables significantly increased sway: the use of nicotine and prescription medications. In the athletes, session-to-session variability and changes due to routine physical activity remained well within 95% confidence intervals defined by the cross-sectional sample for all 3 sway measures. The increase in sway power following a diagnosed concussion was more than an order of magnitude greater than the increases due to session-to-session variability, physical activity, or other participant state variables. Conclusion: The proposed postural sway measures and head-mounted wearable sensor demonstrate analytic utility for on-field detection of abnormal sway that could be potentially useful when making remove-from-activity and return-to-activity decisions for athletes at risk of impact-induced balance impairments.
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Affiliation(s)
- Scott T Grafton
- Department of Psychological & Brain Sciences, UC Santa Barbara, Santa Barbara, CA 93106-9660, USA
| | - Andreas B Ralston
- Clinical Studies Department, Protxx Inc, Menlo Park, CA, 94025-4317, USA
| | - John D Ralston
- Clinical Studies Department, Protxx Inc, Menlo Park, CA, 94025-4317, USA
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