Inner ear concussion

Douglas J Lanska MD FAAN MS MSPH (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released October 22, 2003; last updated January 29, 2017; expires January 29, 2020

This article includes discussion of inner ear concussion, cochlear concussion, commotio labyrinthi, labyrinthine concussion, otitis interna vasomotoria, cochlear concussion, concussion, labyrinthine concussion, middle ear trauma, perilymphatic fistula, post-traumatic benign paroxysmal positioning vertigo, post-traumatic Ménière syndrome, and temporal bone fracture. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

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

Key points

 

• Usually the term “labyrinthine concussion” excludes temporal bone fracture, but there is inconsistent usage of the term.

 

• 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 bone fractures, with longitudinal fractures representing perhaps as many as 80% of temporal bone fractures.

 

• 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 fistulas as a result of oval or round window rupture, shock damage to hair cells, and possibly late development of some cases of Ménière syndrome.

 

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

Historical note and terminology

Auditory and vestibular symptoms are common after closed head injury (Gosselin et al 2006; Hoffer et al 2007; Fife and Kalra 2015) and have been attributed to labyrinthine concussion (Mygind 1918; Grove 1931; Grove 1939; Voss 1934; Schuknecht and Davison 1956; Schuknecht 1969; Fife and Kalra 2015; Lucieer et al 2016) as well as to damage to other central and peripheral vestibular pathways (Marzo et al 2004; Bruno et al 2007; Fife and Kalra 2015). Usually the term “labyrinthine concussion” excludes temporal bone fracture (Schuknecht and Davison 1956; Davey 1965; Schuknecht 1969), although usage of the term is inconsistent (Hunchaisri 2009).

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