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]

• 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]

  Other Pain Conditions Other pain problems associated with mild TBI include neck and back pain, complex regional pain syndrome (CRPS), fibromyalgia, and temporomandibular pain. [practicalpainmanagement.com]

  Post concussive symptoms can include vertigo, headaches, musculoskeletal pain, cervicogenic issues (neck immobility and pain), vision & hearing challenges. [concussion-therapy.com]

• Fishing

  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]

• Nausea

  CONCUSSION SYMPTOM RELIEF Manual therapies alleviate debilitating symptoms such as nausea, dizziness and headaches and enable patients to focus on complete restoration. [concussion-therapy.com]

  […] abruptly and reached a peak within 10 minutes: (1) Palpitations, pounding heart, or accelerated heart rate (2) Sweating (3) Trembling or shaking (4) Sensations of shortness of breath or smothering (5) Feeling of choking (6) Chest pain or discomfort (7) Nausea [books.google.com]

  • Symptoms of labyrinthine concussion may include vertigo, postural imbalance, hearing loss, tinnitus, nausea, vomiting, or some combination of these after head trauma. • Longitudinal temporal bone fractures are far more common than transverse temporal [medlink.com]

  It can cause a headache or neck pain, nausea, ringing in the ears, dizziness, and tiredness. [icdlist.com]

  The symptoms of BPPV include vertigo, light-headedness, nausea, and imbalance. The vertigo may be violent and last less than 60 seconds. [veterans.gc.ca]

• Vomiting

  • Symptoms of labyrinthine concussion may include vertigo, postural imbalance, hearing loss, tinnitus, nausea, vomiting, or some combination of these after head trauma. • Longitudinal temporal bone fractures are far more common than transverse temporal [medlink.com]

  Associated symptoms may be present, such as nausea, vomiting, temporoparietal headaches, a sensations of warmth, sweating, etc. [fundacionmapfre.org]

  […] opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Shows mood, behavior, or personality changes Can’t recall events prior to hit or fall Can’t recall events after hit or fall Headache or “pressure” in head Nausea or vomiting [wwpsa.org]

  It often leads to nausea and vomiting. Central vertigo is generally less severe than peripheral vertigo and is often associated with other signs of central nervous system disease. Vertigo is multifactorial. [veterans.gc.ca]

  Bed rest and labyrinthine sedatives are given during initial few days of severe nausea and vomiting, as drugs delay central compensation. Corticosteroids are indicated for several days, in case of trauma-induced edema. [indianjotol.org]

• Sweating

  الصفحة 455 - A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: (1) Palpitations, pounding heart, or accelerated heart rate (2) Sweating (3) Trembling [books.google.com]

  I was sweating, sick, nauseous, throwing up and couldn't walk. I finally made it to the bathroom and could see I had dried blood under my nose. The back right side of my head was so sore I couldn't touch it (hurt for months). [medhelp.org]

  Associated symptoms may be present, such as nausea, vomiting, temporoparietal headaches, a sensations of warmth, sweating, etc. [fundacionmapfre.org]

• Diplopia

  Up to 50% of patients with mild traumatic brain injury develop a post-concussion syndrome ( Miller Fisher, 1966 ; Rutherford, 1977 ; Williams et al., 1990 ) (dizziness, headache, tinnitus, hearing loss, blurred vision, diplopia, anxiety, irritability, [functionalneurology.com]

  Peripheral vertigo should not be accompanied by any other sign of damage to the nervous system (such as: incoordination of the hands; diplopia or dysconjugate eye movements; loss of sensation; or weakness). [dartmouth.edu]

  VASCULAR ISCHEMIA The sudden onset of vertigo in a patient with additional neurologic symptoms (e.g., diplopia, dysarthria, dysphagia, ataxia, weakness) suggests the presence of vascular ischemia. [aafp.org]

• Fracture

  or some combination of these after head trauma. • Longitudinal temporal bone fractures are far more common than transverse temporal bone fractures, with longitudinal fractures representing perhaps as many as 80% of temporal bone fractures. • A variety [medlink.com]

  Abstract Blunt head trauma without any temporal bone fracture or longitudinal temporal bone fracture, with an associated fracture of the labyrinth may cause labyrinthine injury with sensor neural hearing loss and vertigo because of a concussive injury [ncbi.nlm.nih.gov]

  On roentgenograms the fracture usually [researchgate.net]

• Contusion

  Ear injuries due to pressure changes: they may occur in pilots, parachuters, scuba divers, caisson workers and as a result of explosions or contusions. [fundacionmapfre.org]

  The commonest contrecoup injury was cerebral contusion, followed by extradural haematoma and subdural haematoma. [researchgate.net]

  Post-traumatic cerebral contusion located along the Heschl’s gyrii may be responsible for SNHL (Fig. 13 ). [link.springer.com]

• Muscle Spasm

  Tension-type headaches are associated with muscle tension or muscle spasms and stress. [braininjurysupport.org]

• Tinnitus

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

  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]

• Benign Paroxysmal Positional Vertigo

  paroxysmal positioning vertigo, post-traumatic Ménière syndrome, and temporal bone fracture. [medlink.com]

  Comparison of effectiveness of maneuvers and medication in the treatment of benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec. 1997;59:155-158. [dentalcareuniverse.com]

  Dix-Hallpike maneuver (used to diagnose benign paroxysmal positional vertigo). [aafp.org]

  The differential for posttraumatic vertigo is significant including benign paroxysmal positional vertigo, perilymphatic fistula, and posttraumatic Ménière’s disease (or endolymphatic hydrops), which have been addressed in previous chapters. [oxfordindex.oup.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]

• Hyperacusis

  – convergence insufficiency – horizontal and vertical (heterophoria), problems with tracking and saccades, peripheral vision problems, eyes see different colour tints; tinnitus 24/7 both ears; hyperacusis (noise filter gone!) [neurotalk.org]

  Hearing loss may be transient, lasting for minutes to hours, or permanent, with symptoms of tinnitus and hyperacusis. Inner ear damage caused by explosions results from a combination of the blast wave and the following impulse sound. [diversifiedhearing.com]

  Dizziness, nausea and, at times, tinnitus and hyperacusis are also symptoms that are quite commonly included in this syndrome. [redorbit.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]

• 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]

  Posttraumatic tinnitus can be both non-pulsatile and pulsatile. 2. Posttraumatic non-pulsatile tinnitus can result from trauma to the ear or neck. [researchgate.net]

  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]

• Mood Swings

  There are also many emotional/behavioral problems associated with TBI, including depression, apathy, anxiety, irritability, anger, paranoia, confusion, frustration, agitation, sleep problems, and mood swings. [diversifiedhearing.com]

• Vertigo

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

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

• Dizziness

  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]

• Difficulty Concentrating

  Balancing Vision Changes Photophobia Phonophobia Feeling “out of it” Difficulty Concentrating Tinnitus Drowsiness Sadness/Emotional changes Hallucinations Symptoms typically resolve in 7-10 days with active rest and the appropriate structured gradual [wwpsa.org]

  Frequently such patients also complain of headache and have difficulty concentrating (post-concussion syndrome). [functionalneurology.com]

• Aphasia

  Slight aphasia. Shooting pain up neck and limited mobility at neck. Otherwise lucky! [neurotalk.org]

  Neurological deficits (weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not be transient Intracranial lesion While no standard definition or diagnostic criteria for mild TBI currently exist [diversifiedhearing.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]

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]

Treatments may include vestibular therapy. Common symptoms reported by people with inner ear concussion Reports may be affected by other conditions and/or medication side effects. [patientslikeme.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]

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]

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]

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]

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.