Labyrinthine concussion, also known as inner ear concussion, or commotion labyrinthitis /otitis interna vasomotoria [1] is characterized by a sensorineural hearing loss in the high frequencies. It follows vestibular or head trauma and may or may not be associated with vertigo. Some patients may report symptoms despite the absence of radiological evidence of labyrinthine injury [2] [3].

Typical features of labyrinthine concussion are a reversible hearing loss, dizziness, and tinnitus on the ipsilateral side, although they can also be seen on the contralateral side of the temporal bone fracture [1] or can be bilateral [4]. The symptoms are noticed either immediately or within an hour or even days after the injury [4]. Nystagmus and alteration in hearing are a prerequisite to label the condition as labyrinthine concussion [4]. Nystagmus is initially in the ipsilateral direction, horizontal, torsional or directional and later changes direction towards the contralateral side. The hearing loss is in the high frequencies and can be either mild to moderate or even profound. Patients may witness with recruitment [4].

The causes of labyrinthine concussion are unknown and it is presumed that injury of the saccule and utricle occurs following trauma to their encasing bony labyrinth with resultant hemorrhage, ischemia or rupture of parts of the membranous labyrinth [5] [6].

• Falling

  Audiologists should be aware of the greater fall risk of elderly patients and the need for follow-up hearing testing when a fall occurs, even in the absence of vestibular complaints. [journals.lww.com]

• Loss of Hair

  He produced shock pulses in the fluids of the labyrinth in cats, and found loss of hair cells and spiral ganglion cells in the middle turns of cochlea. [ncbi.nlm.nih.gov]

• Choking

  During these attacks there are symptoms such as shortness of breath or smothering sensations; palpitations, pounding heart, or accelerated heart rate; chest pain or discomfort; choking; and fear of going crazy or losing control. ‏ [books.google.com]

• Shoulder Pain

  These may also be the same primary complaints of patients with whiplash association disorder, with the addition of chronic neck and shoulder pain, tinnitus, and possibly also hearing loss. [journals.lww.com]

• Tinnitus

  A labyrinthine concussion is a condition which occurs following trauma to the head and/or inner ear or can also present without well-defined radiological injury and is characterized by inner ear symptoms such as tinnitus, dizziness, and high-frequency [symptoma.com]

  Because of the damage to the inner ear structures, tinnitus is also frequently reported. [journals.lww.com]

• Sudden Hearing Loss

  Sudden hearing loss caused by labyrinthine hemorrhage. Braz J Otorhinolaryngol. 2008 ; 74 (5): 776 – 779. Google Scholar Crossref Medline 10. Flint, P Haughey, B. Etiology of Sensorineural Hearing Loss. [journals.sagepub.com]

  Sudden hearing loss caused by labyrinthine hemorrhage. Braz J Otorhinolaryngol. 2008; 74 ( 5 ): 776–779. [ PubMed ] [ Google Scholar ] 10. Flint P Haughey B et al. Etiology of Sensorineural Hearing Loss. [ncbi.nlm.nih.gov]

  If your sudden hearing loss is combined with any of the following symptoms, it is an indication of traumatic brain injury, and you should call 911 or seek immediate medical care: Facial droop Numbness or paralysis on one side of the face or body Eye or [torklaw.com]

  These should be suspected in cases of sudden hearing loss after digital manipulation of the external auditory canal [ 24 ]. [link.springer.com]

• Labyrinth Disease

  Keywords: temporal region trauma, post-concussion symptoms, CT and MR imaging, labyrinth diseases, sensorineural hearing loss Introduction Annually, 5% of the population sustain head injuries. [ncbi.nlm.nih.gov]

• Hot Flushes

  flushes Table 3.2. ‏ [books.google.com]

• Vertigo

  Vertigo without a demonstrable fracture may also be the result of labyrinthine concussion, cupololithiasis and perilymphatic fistula. [ncbi.nlm.nih.gov]

  It follows vestibular or head trauma and may or may not be associated with vertigo. Some patients may report symptoms despite the absence of radiological evidence of labyrinthine injury. [symptoma.com]

  Show Summary Details Preview Posttraumatic vertigo is commonly encountered. [oxfordindex.oup.com]

  Labyrinthine Concussion and Positional Vertigo After Osteotome Site Preparation Labyrinthine Concussion and Positional Vertigo After Osteotome Site Preparation June 2004 Flanagan, Dennis DDS Implant Dentistry: Volume 13(2) June 2004 pp 129-132 Please [dentalcareuniverse.com]

• Dizziness

  A labyrinthine concussion is a condition which occurs following trauma to the head and/or inner ear or can also present without well-defined radiological injury and is characterized by inner ear symptoms such as tinnitus, dizziness, and high-frequency [symptoma.com]

  Dizziness and tinnitus were two commonly accompanied symptoms. Dizziness was associated in 20 ears (32%) whereas tinnitus in 41 ears (66%). [ncbi.nlm.nih.gov]

• Nystagmus

  Slight nystagmus on fistula test is indicative of oval or round window fistulae while strong nystagmus can indicate superior semicircular canal dehiscence. Dix-Hallpike maneuver is administered as part of the examination. [symptoma.com]

  If a vestibular component is suspected, vision-denied, recordable nystagmus is present, initially beating towards the irritated ear. Nystagmus is typically horizontal or torsional and direction-fixed. [journals.lww.com]

• Gait Ataxia

  A specialist examination for dizziness was performed with past pointing, Romberg sign, gait ataxia and moving platform posturogra-phy, helpful to quantify balance deficits. [ncbi.nlm.nih.gov]

• Thalamic Pain

  Get a broader perspective on your field from new chapters on Labral Tears of the Shoulder and Hip, Pubalgia, Chondral Injuries, Central Post-Stroke Pain (Thalamic Pain Syndrome), Chemotherapy-induced Peripheral Neuropathy, Radiation Fibrosis Syndrome, [books.google.com]

History, examination findings, audiological evaluation and psychological assessment are necessary to distinguish between labyrinthine concussion from post-concussion syndrome and whiplash syndrome, which may be concurrent [4]. All these patients can complain of dizziness, although a migraine and headaches are more common in post-concussion syndrome while patients with whiplash syndrome may have long-standing shoulder and neck pain with tinnitus and hearing loss. Benign positional vertigo (BPPV) may be noticed in all the three groups of patients [4]. However, patients with a labyrinthine concussion recover faster as compared to other syndromic patients.

A complete otolaryngological and neurologic examination is performed along with the tuning forks test to document hearing loss. Slight nystagmus on fistula test is indicative of oval or round window fistulae [7] while strong nystagmus can indicate superior semicircular canal dehiscence. Dix-Hallpike maneuver is administered as part of the examination. Caloric testing will not reveal central problems and cerebellar signs will be absent. Pure tone audiometry is helpful to document the degree and type of hearing loss while tympanometry is useful to assess the tympanic membrane and middle ear status. Hearing loss is usually sensorineural and more often in the higher frequencies [3]. Electronystagmography (ENG) is performed to differentiate between central and peripheral vertigo [4].

High resolution computed tomography (CT) scan of the temporal bone can detect fractures which can be either transverse or longitudinal. The incidence of vestibular injury is higher with transverse fractures. Magnetic resonance imaging (MRI) of the temporal bone and internal auditory canal (IAM), help to exclude associated tumors.

1. Ulug T, Ulubil SA. Contralateral labyrinthine concussion in temporal bone fractures. J Otolaryngol. 2006;35:380–383.
2. Canalis RF, Lambert PR. The ear: comprehensive otology. Philadelphia (PA): Lippincott Williams & Wilkins; 1999. pp. 795–796.
3. Choi MS, Shin S-O, Yeon JY, Choi YS, Kim J, Park SK. Clinical Characteristics of Labyrinthine Concussion. Korean J Audiol. 2013;17(1):13-17. doi:10.7874/kja.2013.17.1.13.
4. Colucci D. Understanding Labyrinthine Concussion. Hearing Journal. April 2017; 70 (4): 44 - 46
5. Weissman JL, Curtin HD, Hirsch BE, Hirsch WL Jr. High signal from the otic labyrinth on unenhanced magnetic resonance imaging. AJNR Am J Neuroradiol 1992;13(4):1183–1187
6. Lindsay JR, Zajtchuk J. Concussion of the inner ear. Ann Otol Rhinol Laryngol 1970;79(4):699–709
7. Rambold H, Heide W, Sprenger A, Haendler G, Helmchen C. Perilymph fistula associated with pulse-synchronous eye oscillations. Neurology. 2001 Jun 26; 56(12):1769-71.