Neurotologic Evaluation and Treatment Following Minor Head Trauma

Abstract

Otologic symptoms occur commonly following head injury. Dizziness, tinnitus, hearing loss, and even facial paralysis may occur following trauma, often in association with headache, memory loss, lethargy, irritability, and other neurologic complaints discussed elsewhere in this book. For many years, auditory and vestibular symptoms following trauma were considered psychogenic. However, organic causes for these complaints have been established and accepted for at least the last two decades (1,2). Following severe head injury, the mechanisms are clear. They include localized middle or inner ear injury from direct trauma to the ear and temporal bone, labyrinthine concussion, injury to the seventh and eighth neurovascular bundles (ipsilateral or contra coup), and injury to the brainstem or higher pathways. In cases of severe head injury, isolated auditory and vestibular symptoms are unusual, but severe dizziness and ataxia, inability to discriminate or process speech signals, tinnitus, and other otologic problems occur frequently in association with other signs and symptoms of neurologic injury. Vestibular symptoms associated with mild head trauma and “inner ear concussion” are also well recognized (3). When neurotologic symptoms occur following minor head trauma, they may be the most prominent post-traumatic complaints, or they may be subtle. Consequently, all patients with symptoms of hearing loss, tinnitus, dizziness, or facial nerve dysfunction following head trauma should undergo comprehensive neurotologic evaluation.