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Labyrinthine Concussion

Vestib Trauma Fm Head Injury

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 sensorineural hearing loss.


Presentation

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]
Chills
  • […] dizzy, unsteady, lightheaded, or faint (9) derealization (feelings of unreality) or depersonalization (being detached from oneself) (10) fear of losing control or going crazy (11) fear of dying (12) paresthesias (numbness or tingling sensations) (13) chills[books.google.com]
Palpitations
  • 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]
Chest Pain
  • 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]
Pulsatile Tinnitus
  • The focus is on patients presented with vertigo, disequilibrium, hearing loss, pulsatile and non-pulsatile tinnitus, facial nerve weakness, and complications of the otitis media.[books.google.com]
  • 2 Responses Did you tell your neurotologist about the pulsatile tinnitus? Have you had an MRA, to show possible blood-vessel problems that might be related to your symptoms? Your case sounds complicated.[medhelp.org]
Depersonalization
  • Trembling or shaking (4) Sensations of shortness of breath or smothering (5) Feeling of choking (6) Chest pain or discomfort (7) Nausea or abdominal distress (8) Feeling dizzy, unsteady, lightheaded, or faint (9) Derealization (feelings of unreality) or depersonalization[books.google.com]
Hot Flushes
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]
  • Publisher Full Text How to diagnose cervicogenic dizziness.[unboundmedicine.com]
  • It has been reported that approximately 50% of head and neck injuries result in dizziness and disequilibrium.[balancechicago.wordpress.com]
  • The main symptoms of labyrinthine concussion are hearing loss, tinnitus, and dizziness. The diagnosis mainly relies on audiometric tests, which reveal characteristic tracings reminiscent of acoustic trauma.[ncbi.nlm.nih.gov]
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]
  • vertigo, migraine-related vertigo, post-concussion syndrome.[balancechicago.wordpress.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]
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]
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]
Dystonia
  • Stay current with expanded and updated coverage of diagnosis, management and rehabilitation of Cervical Dystonia, Suprascapular Neuropathy, Epicondylitis, Temporomandibular Joint Pain, Spinal Cord Injury, Stroke, Adhesive Capsulitis of the Hip, and Adductor[books.google.com]

Workup

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.

Treatment

  • Treatment of benign vertigo using heels-over-head rotation. Ann Otol Rhinol Laryngol. 1998;107:1046-1053. 14. Itaya T, Yamamoto E, Kitano H, et al.[dentalcareuniverse.com]
  • There is a discussion of labyrinthine concussion and treatments. Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use.[ncbi.nlm.nih.gov]
  • Practical, clinically relevant material facilitates the diagnosis and treatment of musculoskeletal, pain, and chronic disabling conditions.[books.google.com]
  • The appropriate diagnostic work up and treatment options as well as controversies will be discussed in the context of evidence-based medicine and "best practice" approach.[books.google.com]
  • Current treatments: Vestibular therapy, Vision therapy, amantadine (100 mg a day), acupuncture and physiotherapy for neck, slow return to exercise, magnesium, resveratrol, omega 3 fish oils, vitamins D, B and multi. Optimism and perserverance.[neurotalk.org]

Prognosis

  • Prognosis and outcomes Post-concussion syndrome prognosis depends on a variety of factors, however for most people, symptoms resolve within one year of the inciting injury. 9 However, as we noted previously, dizziness can last for several years, ultimately[theraspecs.com]
  • Good prognosis for recovery with medical treatment, which are steroids and antibiotics. Labyrinthitis Symptoms Vertigo, sensorineural hearing loss.[quizlet.com]
  • The prognosis for hearing function is worse than for vestibular symptoms 8 . In some cases, onset may be delayed by several days. These symptoms typically are short-lived and gradually subside over a period of days to weeks.[ncbi.nlm.nih.gov]
  • There are several good treatments for BPPV and the prognosis for this syndrome, in the proper hands, is excellent.[tchain.com]

Etiology

  • In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding or concussion, which were difficult to diagnose before the advent of magnetic resonance imaging.[ncbi.nlm.nih.gov]
  • Our study ruled out a variety of possible etiologies for post-traumatic auditory and vestibular dysfunction through radiological resources.[ncbi.nlm.nih.gov]

Epidemiology

  • Injury Epidemiology. 2015;2(1):22. doi:10.1186/s40621-015-0055-2. 14 Lynch JM, Anderson M, Benton B, Green SS. The Gaming of Concussions: A Unique Intervention in Postconcussion Syndrome.[theraspecs.com]
  • Epidemiology including risk factors and primary prevention Reports of dizziness, changes in balance and/or coordination have been estimated to be 15-78% in mild TBI.[now.aapmr.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology, presentation, diagnosis, and management of these entities is discussed in detail in a clear, easy to understand format.[books.google.com]
  • Pathophysiology the Biologic Basis for Disease in Adults and Children, 3rd ed. St. Louis: Mosby; 1998:449-451. 6. Jackler RK, Kaplan MJ. Ear, nose and throat. In: Tierney LM, McPhee SJ, Papadakis MA, eds.[dentalcareuniverse.com]
  • Explain the pathophysiology of a concussion Recognize who is most at risk of sustaining a concussion Discuss the functional anatomy of the central nervous system and balance system Recognize the differences between the cortical recovery process and central[ipta.org]
  • Overview The author explains the clinical presentation, pathophysiology, and differential diagnosis of inner ear concussion, a common cause of auditory and vestibular symptoms after closed head injury.[medlink.com]

Prevention

  • Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use.[ncbi.nlm.nih.gov]
  • Develop a thorough, clinically relevant understanding of interventions such as physical agents and therapeutic exercise in the prevention, diagnosis, treatment, and rehabilitation of disorders that produce pain, impairment, and disability.[books.google.com]
  • Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use. References 1. Summers RB.[dentalcareuniverse.com]
  • The Centers for Disease Control and Prevention reported that about 800,000 people a year are seen in emergency rooms for falls, resulting in bone fractures or head trauma (CDC, 2017 ).[journals.lww.com]

References

Article

  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.

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Last updated: 2017-08-09 13:44