Correction to: Constant severe imbalance following traumatic otoconial loss: a new explanation of residual dizziness (original) (raw)
Related papers
European Archives of Oto-Rhino-Laryngology
Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo, caused by otoconia falling from the utricle into a semicircular canal (SCC). After successful repositioning maneuvers residual dizziness (RD) has been described and several reasons are used to explain RD. It can last for only a few days or weeks, but also much longer. We present a patient with a severe traumatic loss of otoconia from both maculae utriculi and a persistent imbalance more than 9 years. We think that the loss of otoconia from the utricular and probably also saccular macula induced a sudden reduction of her ability to sense gravity thus logically explaining her symptoms. We show the vestibular test results also supporting our hypothesis and we extrapolate this support to other forms of so far unexplained dizziness especially increasing imbalance with aging. We also discuss the normal c-and oVEMP indicating intact haircell function and supporting our hypothesis of isolated otoconial loss as the major cause for imbalance.
Otolith function in patients with head trauma
European Archives of Oto-Rhino-Laryngology, 2011
This study evaluates the otolith function of patients with head trauma, postulating that otolith dysfunction is a cause of nonspecific dizziness after head trauma. We prospectively enrolled 28 patients referred within 3 months after head trauma between March 2007 and December 2009. Pure tone audiometry, caloric testing and otolith function tests, including cervical vestibular evoked myogenic potential (cVEMP) and subjective visual vertical (SVV) tests, were performed on all patients. The relationship between otolith function and otologic symptoms was analyzed. Of the 28 patients with head trauma, 18 complained of dizziness and 12 experienced hearing loss, including 6 patients who complained of both. On defining otolith dysfunction as an abnormal cVEMP or abnormal SVV, a significant difference in otolith dysfunction existed between the groups with and without dizziness [72 (13/18) vs. 20% (2/10)]. In contrast, no significant difference in otolith dysfunction was detected between the abnormal and normal hearing groups. A significant number of the patients who complained of nonspecific dizziness after trauma had abnormal otolith function. After trauma, when patients complain of dizziness, vestibular function tests, including otolith function tests, should be considered.
Otoconial loss or lack of otoconia – An overlooked or ignored diagnosis of balance deficits
Medical Hypotheses, 2019
Lack of otoconia or otoconial loss may be the major reason for increasing imbalance with age, posttraumatic dizziness and residual dizziness as well as other so far unexplained imbalance affecting probably millions of people. Background: It is written in every textbook that we need sensation of gravity for stable gait and stance, especially on two legs. Lack of otoconia is known to cause lifelong balance problems in animals. Loss of otoconia is happening in aging humans, like shown by increasing incidence of benign paroxysmal positional vertigo (BPPV) and in histological sections. While hundreds of papers have been published on BPPV, increasing imbalance with age and increasing falls, none has ever described the loss of otoconia as a major reason for this imbalance. Maybe this is due to the problems to proof this hypothesis in an individual patient. We will explain why otoconial loss may cause dizziness, postural and locomotor instability in patients with no other identifiable cause or in addition to other causes. Several reasons can cause otoconial loss and lead to the described symptoms. We will describe the symptoms and the tests which could in combination support the diagnosis. Conclusion: Our hypothesis argues for the new diagnosis in many patients with so far undiagnosed or incorrectly or incompletely diagnosed dizziness or imbalance. Introduction/background Otoconial loss and BPPV Loss of otoconia from the utricle often leads to BPPV. We know, that the prevalence of BPPV increases continuously from a 1-year prevalence of 0.5% in the 18-39 year age group up to 3.4% in those aged 60 and older, reaching a cumulative lifetime incidence of 10% by the age of 80 [1]. The most common form of vertigo is idiopathic BPPV BPPV can also be caused by head trauma [2]. Patients often experience lightheadedness, dizziness, or short-lasting unsteadiness following successful repositioning maneuvers for BPPV, which is called residual dizziness (RD) [3]. RD occurs with an incidence of 31-61% and more often with increasing age above 65 years [4]. Several reasons for RD are debated, such as anxiety or loss of utricular function. The latter means, in general, a loss of utricular haircell function, rather than isolated otoconial degeneration, although von Brevern et al [5] suggested macular degeneration as consequence of a utricular lesion. One possible, so far overlooked, reason for RD may be isolated otoconial loss in the absence of haircell loss or damage, particularly for long lasting RD. The duration of RD is often estimated in weeks, but much longer imbalance is also reported [6,7]. The short lasting RD directly after successful repositioning maneuvers could also be explained by otoconia falling back on the utricle thus changing the sensation of gravity, i.e. our sensation of gravity could change with the changing weight of the otoconial membrane. Whether increasing or decreasing macular weights have different effects is still unknown. Other causes of imbalance Causes of postural and locomotor instability or dizziness other than RD are commonly thought to be nonspecific and multi-factorial; among
Tinnitus after head injury: evidence from otoacoustic emissions
Journal of Neurology, Neurosurgery & Psychiatry, 1998
Objective-Tinnitus may be caused by a lesion or dysfunction at any level of the auditory system. This study explores cochlear mechanics using otoacoustic emissions in patients with tinnitus after head injury, in whom there seems to be evidence to support dysfunction within the CNS. Methods-The study included 20 patients with tinnitus and other auditory symptoms, such as hyperacusis and diYculty in listening in background noise, after head injury, in the presence of an "intact" auditory periphery (normal or near normal audiometric thresholds). They were compared with 20 normal subjects and 12 subjects with head injury, but without tinnitus, who had similar audiometric thresholds. In all subjects otoacoustic emissions, including transient clickevoked (TEOAEs) and spontaneous otoacoustic emissions (SOAEs), were recorded, and a test of eVerent medial olivocochlear suppression, consisting of recording of TEOAEs under contralateral stimulation, was performed. Results-A significantly higher prevalence of SOAEs (100%), higher TEOAE response amplitudes, and reduced medial olivocochlear suppression in patients with tinnitus in comparison with subjects without tinnitus have been found. Conclusion-These findings have been interpreted to be an extracochlear phenomenon, in which the reduction in central eVerent suppression of cochlear mechanics, leading to an increase in cochlear amplifier gain, was subsequent to head injury. Auditory symptoms in these patients seemed to constitute the "disinhibition syndrome". (J Neurol Neurosurg Psychiatry 1998;65:523-529)
Vestibular agnosia in traumatic brain injury and its link to imbalance
Brain, 2020
Vestibular dysfunction, causing dizziness and imbalance, is a common yet poorly understood feature in patients with TBI. Damage to the inner ear, nerve, brainstem, cerebellum and cerebral hemispheres may all affect vestibular functioning, hence, a multi-level assessment—from reflex to perception—is required. In a previous report, postural instability was the commonest neurological feature in ambulating acute patients with TBI. During ward assessment, we also frequently observe a loss of vertigo sensation in patients with acute TBI, common inner ear conditions and a related vigorous vestibular-ocular reflex nystagmus, suggesting a ‘vestibular agnosia’. Patients with vestibular agnosia were also more unbalanced; however, the link between vestibular agnosia and imbalance was confounded by the presence of inner ear conditions. We investigated the brain mechanisms of imbalance in acute TBI, its link with vestibular agnosia, and potential clinical impact, by prospective laboratory assessm...
Otoneurological Evaluation and Rehabilitative Considerations after Head Trauma
IntechOpen eBooks, 2023
Head injuries due to traffic accidents, falls, gunshots and blows in sports fights, among others, with or without a skull or petrosal fractures, can lead to a Traumatic Labyrinth Concussion (TLC), defined as a disorder of the peripheral vestibular system comprising vestibular, auditory and neurovegetative signs and symptoms, which can persist for weeks or months after a traumatic injury. It is often accompanied by central nervous system (CNS) concussion, manifested by objective symptoms such as tachycardia, headache, thermoregulatory instability and mydriasis; and subjective complaints such as emotional disorders, memory loss, visual disorders, insomnia, hyperemotivity and behaviour disorders. Otoneurologic examination is relevant in the identification and topographic diagnosis of vestibular disorders This chapter will verse on symptoms, audiometric and vestibular findings in TLC, as well as rehabilitation perspectives.
Auditory and vestibular dysfunction associated with blast-related traumatic brain injury
The Journal of Rehabilitation Research and Development, 2009
The dramatic escalation of blast exposure in military deployments has created an unprecedented amount of traumatic brain injury (TBI) and associated auditory impairment. Auditory dysfunction has become the most prevalent individual service-connected disability, with compensation totaling more than 1 billion dollars annually. Impairment due to blast can include peripheral hearing loss, central auditory processing deficits, vestibular impairment, and tinnitus. These deficits are particularly challenging in the TBI population, as symptoms can be mistaken for posttraumatic stress disorder, mentalhealth issues, and cognitive deficits. In addition, comorbid factors such as attention, cognition, neuronal loss, noise toxicity, etc., can confound assessment, causing misdiagnosis. Furthermore, some auditory impairments, such as sensorineural hearing loss, will continue to progress with age, unlike many other injuries. In the TBI population, significant clinical challenges are the accurate differentiation of auditory and vestibular impairments from multiple, many times overlapping, symptoms and the development of multidisciplinary rehabilitation strategies to improve treatment outcomes and quality of life for these patients.
Original Articles Dynamics of Hearing Status in Closed Head Injury
Hearing impairment can be one of the more subtle deficits seen after closed head injury (CHI), and it may not be diagnosed until late in the recovery phase if at all. Most studies have assessed patients immediately after CHI. Repeated assessments at regular intervals were not performed in the majority of studies done to assess whether any initial hearing loss regressed or progressed. Follow-up at later stages will shed more light on the audio-logical consequences of CHI. The aim of this study was to analyze the long-term audiological consequences of CHI. A total of 290 subjects with CHI were chosen and followed-up at 3, 6, and 12 months. The audiological test battery comprised pure tone audiometry (PTA), speech audiometry, tympanometry, auditory brainstem response (ABR), and middle latency response (MLR), and was administered to all subjects. The data from 96 subjects who completed all three follow-ups were analyzed for tympanometry, ABR, and MLR. However, for PTA and speech audiometry, data from only 76 subjects were analyzed, as unconscious and disoriented subjects could not undergo these tests at initial testing. The results revealed that hearing status after CHI varies, and that at follow-up significant changes in hearing were seen. Hearing of low frequencies improved, due primarily to improvements in middle ear function. Significant changes in ABR latencies and MLR amplitudes were also observed. This reflects the unequal rates of recovery observed in the different parts of the central auditory nervous system.
Hearing Difficulties as a Result of Traumatic Brain Injury
Journal of the American Academy of Audiology, 2019
Background: Traumatic brain injury (TBI) has been shown to result in hearing difficulties (i.e., deficits in the processing of auditory information) without impacting pure-tone threshold detection. A missed diagnosis of hearing difficulties due to TBI because of normal hearing can lead to reductions in quality of life and missed opportunities to provide an appropriate treatment regimen. Purpose: This study presents a case report of a female patient with a history of TBI due to a motor vehicle accident that resulted in a broad range of symptoms, including self-perceived hearing difficulties and poorer-than-normal auditory processing performance. Research Design: Case report. Study Sample: A 58-year-old woman with a history of a mild TBI due to a motor vehicle accident. Data Collection: A neuro-audiology evaluation was conducted to address the patient's hearing complaints. The evaluation included standard audiometric and auditory processing test batteries. Results: The case report focuses on the patient's history of TBI and her presentation to our clinic with hearing complaints. Her clinical audiological outcomes, including an auditory processing assessment, and treatment with mild-gain hearing aids are discussed. The use of mild-gain hearing aids resulted in improved auditory processing skills and a significant improvement in quality of life. Conclusions: Patients with a history of TBI often have multiple and debilitating symptoms, including hearing difficulties. Accurate diagnosis of auditory processing deficits in the face of normal pure-tone detection abilities is essential to provide treatment options that can improve daily function and quality of life.
Audiological Deficits After Closed Head Injury
Background: Damage to the peripheral auditory structures has long been recognized as a common component of head injury. It is estimated that a majority of patients with skull trauma have resultant hearing impairment. Damage to the peripheral and/or central auditory pathways can occur as a primary or secondary injury. Considering the high incidence of hearing loss, it was considered worthwhile to conduct an in-depth investigation by administering a comprehensive audiological test battery on head-injured patients. Method: The sample population consisted of 290 subjects with closed head injury (study group) and 50 subjects with otologically normal subjects (control group). The subjects in the study group were further divided into mild (n 150), moderate (n 100), and severe (n 40) category on the basis of Glasgow Coma Scale score. The audiological assessment consisted of pure tone audiometry, speech audiometry, tympanometry, acoustic reflex testing, auditory brain stem response audiometry, and middle latency response audiometry. Results and Conclusions: It is concluded that there is higher prevalence of hearing impairment in the study group compared with control group. Majority of the patients who incur hearing loss after closed head injury have mild degree of hearing impairment. A significant difference between the study and control group observed on majority of the auditory brain stem response and middle latency response parameters studied.