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]

• 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 sensory neural hearing loss is relatively frequent. In most cases, the etiology is not discovered. [journals.sagepub.com]

  Types of Hearing Damage There are two main types of hearing loss: conductive hearing loss and sensorineural hearing loss. The part of the ear that sustains an injury determines the type of hearing loss the victim suffers. [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]

• Vertigo

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

  Full recovery is the rule for posttraumatic dizziness or vertigo, which seldom persists longer than 3 months after minor traumatic brain injury. [medlink.com]

  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]

• 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]

  A comparative otoneurological study was conducted in two groups of dizzy whiplash patients: patients with dizziness after pure whiplash injury and those with minor injury associated with whiplash. [functionalneurology.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]

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 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]

The condition is usually self limited and supportive therapy and vestibular rehabilitation may be the sole treatment needed. This chapter reviews the clinical presentation, diagnostic evaluation, and treatment of labyrinthine concussion. [oxfordindex.oup.com]

This material provides a springboard for discussion of either a concept in the field of vestibular disorders or the diagnosis or treatment of a particular disease state. Practical, specific treatment options are discussed throughout the book. [books.google.com]

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]

A poor prognosis was correlated with central auditory changes, e.g. central tinnitus or hyperacusis. Moreover, a time interval of several months between the injury and the onset of treatment also worsened the overall prognosis. [researchgate.net]

Good prognosis for recovery with medical treatment, which are steroids and antibiotics. Labyrinthitis Symptoms Vertigo, sensorineural hearing loss. [quizlet.com]

Systematic review of the prognosis after mild traumatic brain injury in adults: cognitive, psychiatric, and mortality outcomes: results of the international collaboration on mild traumatic brain. Injury Prognosis. [scielo.isciii.es]

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]

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]

• A variety of possible etiologies are possible for posttraumatic auditory and vestibular dysfunction, including benign paroxysmal positional vertigo precipitated by labyrinthine concussion or traumatic shearing of otoconia from otolith organs, perilymphatic [medlink.com]

Epidemiology of concussion in collegiate and high school football players. [scielo.isciii.es]

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]

MIGRAINE HEADACHES Epidemiologic evidence shows a strong association between vertigo and migraine. 29 Diagnostic criteria have been proposed to provide a more specific definition of vertiginous migraine. 29 Diagnostic accuracy is important because vertiginous [aafp.org]

The pathophysiology, presentation, diagnosis, and management of these entities is discussed in detail in a clear, easy to understand format. [books.google.com]

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]

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]

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]

NIH: National Institute of Neurological Disorders and Stroke Brain injury - discharge Chronic subdural hematoma EEG Extradural hemorrhage Facts about Concussion and Brain Injury (Centers for Disease Control and Prevention) Head injury - first aid Intracranial [icdlist.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 http://bit.ly/2mZu0jD ). [journals.lww.com]

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.