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  • Updated 10.21.2020
  • Released 10.22.2003
  • Expires For CME 10.21.2023

Inner ear concussion

Introduction

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 (28; 36; 21) and have been attributed to labyrinthine concussion (56; 29; 30; 77; 71; 70; 21; 50; 54) as well as to damage to other central and peripheral vestibular pathways (53; 09; 21). Usually the term “labyrinthine concussion” excludes temporal bone fracture (71; 14; 70), although usage of the term is inconsistent (40).

Around 1900 histologic changes were identified in the temporal bones of individuals that sustained head injury without temporal bone fractures. Animal experiments investigating the pathophysiology of labyrinthine concussion employed either delivery of blows to the head or introduction of a pressure wave into the labyrinthine fluid (05).

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