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Indian Journal of Otolaryngology and Head & Neck Surgery

Erschienen in:

17.08.2020 | Original Article

Vestibular Assessment in Patients with Persistent Symptoms of Mild Traumatic Brain Injury

verfasst von: Sadegh Jafarzadeh, Akram Pourbakht, Eshagh Bahrami

Erschienen in: Indian Journal of Otolaryngology and Head & Neck Surgery | Sonderheft 1/2022

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Abstract

Aim

The estimated worldwide incidence of TBI is 10 million cases per year. Dizziness and imbalance are two common symptoms in mild TBI (mTBI). In about 10–15% of TBI patients, these symptoms remain for a long time and may show no recovery. These persistent symptoms may relate to different factors including vestibular abnormalities. The aim of this study is a vestibular assessment of patients with persistent symptoms of mTBI by different tests including computerized dynamic posturography.

Materials and Methods

21 patients with mTBI evaluated in this study. Patients were civilians with persistent symptoms. TBI did cause by blunt force trauma (mainly from falling) in the past 6 months. They had normal neurologic and musculoskeletal assessments and no temporal bone fracture. Several auditory and vestibular evaluations were performed for each patient. They included: case history, otoscopy, pure tone and speech audiometry, tympanometry, vestibular bedside examination (spontaneous nystagmus, gaze, saccade, pursuit, Dix–Hallpike maneuver, side-lying maneuver, roll, and Romberg test), cervical Vestibular Myogenic Evoked Potential (c-VEMP), Computerized Dynamic Posturography (CDP) and Dizziness Handicap Inventory (DHI).

Results

Patients showed hearing loss in 10 (47.6%) and tinnitus in 4 (19.0%) cases. In ocular motor tests, patients had the most abnormal results in the pursuit test. 6 patients also had Benign Paroxysmal Positional Vertigo (BPPV) in the posterior canal. c-VEMP showed abnormal saccular function in 14 patients. In CDP, the composite scores were decreased relative to normal populations.

Conclusion

vestibular tests showed abnormal results in most patients. Vestibular abnormality could relate to persisting symptoms of mTBI patients.

Donaldson CJ, Hoffer ME, Balough BJ, Gottshall KR (2010) Prognostic assessments of medical therapy and vestibular testing in post-traumatic migraine-associated dizziness patients. Otolaryngology Head and Neck Surgery 143(6):820–825. https://doi.org/10.1016/j.otohns.2010.09.024CrossRefPubMed

Chapman JC, Diaz-Arrastia R (2014) Military traumatic brain injury: a review. Alzheimers Dement 10(3 Suppl):S97–104. https://doi.org/10.1016/j.jalz.2014.04.012CrossRefPubMed

King JE, Pape MM, Kodosky PN (2018) Vestibular test patterns in the NICoE intensive outpatient program patient population. Mil Med 183(suppl1):237–244. https://doi.org/10.1093/milmed/usx170CrossRefPubMed

Dehail P, Petit H, Joseph PA, Vuadens P, Mazaux JM (2007) Assessment of postural instability in patients with traumatic brain injury upon enrolment in a vocational adjustment programme. J Rehabil Med 39(7):531–536. https://doi.org/10.2340/16501977-0096CrossRefPubMed

Mallinson AI, Longridge NS (1998) Specific vocalized complaints in whiplash and minor head injury patients. Am J Otol 19(6):809–813PubMed

Zhou G, Brodsky JR (2015) Objective vestibular testing of children with dizziness and balance complaints following sports-related concussions. Otolaryngol Head Neck Surg 152(6):1133–1139. https://doi.org/10.1177/0194599815576720CrossRefPubMed

Register-Mihalik JK, Mihalik JP, Guskiewicz KM (2008) Balance deficits after sports-related concussion in individuals reporting posttraumatic headache. Neurosurgery 63(1):76–80. https://doi.org/10.1227/01.neu.0000335073.39728.ce(discussion 80-72)CrossRefPubMed

Agostini V, Chiaramello E, Bredariol C, Cavallini C, Knaflitz M (2011) Postural control after traumatic brain injury in patients with neuro-ophthalmic deficits. Gait Posture 34(2):248–253CrossRefPubMed

Kleffelgaard I, Roe C, Soberg HL, Bergland A (2012) Associations among self-reported balance problems, post-concussion symptoms and performance-based tests: a longitudinal follow-up study. Disabil Rehabil 34(9):788–794. https://doi.org/10.3109/09638288.2011.619624CrossRefPubMed

10.

Scherer MR, Schubert MC (2009) Traumatic brain injury and vestibular pathology as a comorbidity after blast exposure. Phys Ther 89(9):980–992. https://doi.org/10.2522/ptj.20080353CrossRefPubMed

11.

Naguib MB, Madian Y, Refaat M, Mohsen O, El Tabakh M, Abo-Setta A (2012) Characterisation and objective monitoring of balance disorders following head trauma, using videonystagmography. J Laryngol Otol 126(1):26–33. https://doi.org/10.1017/s002221511100291xCrossRefPubMed

12.

Lei-Rivera L, Sutera J, Galatioto JA, Hujsak BD, Gurley JM (2013) Special tools for the assessment of balance and dizziness in individuals with mild traumatic brain injury. NeuroRehabilitation 32(3):463–472. https://doi.org/10.3233/nre-130869CrossRefPubMed

13.

Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, Collins MW, Lovell MR, Sparto PJ (2010) Vestibular rehabilitation for dizziness and balance disorders after concussion. JNPT 34(2):87–93. https://doi.org/10.1097/NPT.0b013e3181dde568CrossRefPubMed

14.

Akin FW, Murnane OD (2011) Head injury and blast exposure: vestibular consequences. Otolaryngol Clin North Am 44(2):323–334. https://doi.org/10.1016/j.otc.2011.01.005CrossRefPubMed

15.

Akin FW, Murnane OD, Hall CD, Riska KM (2017) Vestibular consequences of mild traumatic brain injury and blast exposure: a review. Brain Injury 31(9):1188–1194. https://doi.org/10.1080/02699052.2017.1288928CrossRefPubMed

16.

Greer N, Sayer N, Koeller E, Velasquez T, Wilt TJ (2018) Outcomes associated with blast versus nonblast-related traumatic brain injury in US military service members and veterans: a systematic review. J Head Trauma Rehabil 33(2):E16–E29. https://doi.org/10.1097/htr.0000000000000304CrossRefPubMed

17.

Knoll RM, Ishai R, Trakimas DR, Chen JX, Nadol JB Jr, Rauch SD, Remenschneider AK, Jung DH, Kozin ED (2018) Peripheral vestibular system histopathologic changes following head injury without temporal bone fracture. Otolaryngol Head Neck Surg 160(1):122–130. https://doi.org/10.1177/0194599818795695CrossRefPubMed

18.

Ernst A, Basta D, Seidl RO, Todt I, Scherer H, Clarke A (2005) Management of posttraumatic vertigo. Otolaryngol Head Neck Surg 132(4):554–558. https://doi.org/10.1016/j.otohns.2004.09.034CrossRefPubMed

19.

Hebert JR, Forster JE, Stearns-Yoder KA, Penzenik ME, Brenner LA (2018) Persistent symptoms and objectively measured balance performance among OEF/OIF veterans with remote mild traumatic brain injury. J Head Trauma Rehabil 33(6):403–411. https://doi.org/10.1097/htr.0000000000000385CrossRefPubMed

20.

Hoffer ME, Schubert MC, Balaban CD (2015) Early diagnosis and treatment of traumatic vestibulopathy and postconcussive dizziness. Neurol Clin 33(3):661–668. https://doi.org/10.1016/j.ncl.2015.04.004CrossRefPubMed

21.

Hoffer ME, Balaban C, Gottshall K, Balough BJ, Maddox MR, Penta JR (2010) Blast exposure: vestibular consequences and associated characteristics. Otol Neurotol 31(2):232–236. https://doi.org/10.1097/MAO.0b013e3181c993c3CrossRefPubMed

22.

Lien S, Dickman JD (2018) Vestibular injury after low-intensity blast exposure. Front Neurol 9:297. https://doi.org/10.3389/fneur.2018.00297CrossRefPubMedCentralPubMed

23.

Johnson CM, Perez CF, Hoffer ME (2014) The implications of physical injury on otovestibular and cognitive symptomatology following blast exposure. Otolaryngol Head Neck Surg 150(3):437–440. https://doi.org/10.1177/0194599813515184CrossRefPubMed

24.

Lee JD, Park MK, Lee BD, Park JY, Lee TK, Sung KB (2011) Otolith function in patients with head trauma. Eur Arch Otorhinolaryngol 268(10):1427–1430. https://doi.org/10.1007/s00405-010-1426-5CrossRefPubMed

25.

Kisilevski V, Podoshin L, Ben-David J, Soustiel JF, Teszler CB, Hafner H, Chistyakov A (2001) Results of otovestibular tests in mild head injuries. Int Tinnitus J 7(2):118–121PubMed

26.

Basford JR, Chou LS, Kaufman KR, Brey RH, Walker A, Malec JF, Moessner AM, Brown AW (2003) An assessment of gait and balance deficits after traumatic brain injury. Arch Phys Med Rehabil 84(3):343–349. https://doi.org/10.1053/apmr.2003.50034CrossRefPubMed

27.

Kaufman KR, Brey RH, Chou LS, Rabatin A, Brown AW, Basford JR (2006) Comparison of subjective and objective measurements of balance disorders following traumatic brain injury. Med Eng Phys 28(3):234–239CrossRefPubMed

28.

Pickett TC, Radfar-Baublitz LS, McDonald SD, Walker WC, Cifu DX (2007) Objectively assessing balance deficits after TBI: role of computerized posturography. J Rehabil Res Dev 44(7):983–990CrossRefPubMed

29.

Mallinson AI, Longridge NS (1998) Dizziness from whiplash and head injury: differences between whiplash and head injury. Am J Otol 19(6):814–818PubMed

30.

Gattu R, Akin FW, Cacace AT, Hall CD, Murnane OD, Haacke EM (2016) Vestibular, balance, microvascular and white matter neuroimaging characteristics of blast injuries and mild traumatic brain injury: four case reports. Brain Injury 30(12):1501–1514. https://doi.org/10.1080/02699052.2016.1219056CrossRefPubMed

31.

Lahat E, Barr J, Klin B, Dvir Z, Bistrizer T, Eshel G (1996) Postural stability by computerized posturography in minor head trauma. Pediatr Neurol 15(4):299–301CrossRefPubMed

32.

Longridge NS, Mallinson AI (2005) Visual vestibular mismatch in work-related vestibular injury. Otol Neurotol 26(4):691–694CrossRefPubMed

33.

Vonk J, Horlings CG, Allum JH (2010) Differentiating malingering balance disorder patients from healthy controls, compensated unilateral vestibular loss, and whiplash patients using stance and gait posturography. Audiol neuro-Otol 15(4):261–272. https://doi.org/10.1159/000258682CrossRef

34.

Kogler A, Lindfors J, Odkvist LM, Ledin T (2000) Postural stability using different neck positions in normal subjects and patients with neck trauma. Acta Otolaryngol 120(2):151–155CrossRefPubMed

35.

Jafarzadeh S, Pourbakht A, Bahrami E, Jalaie S, Bayat A (2018) Effect of early vestibular rehabilitation on vertigo and unsteadiness in patients with acute and sub-acute head trauma. Iran J Otorhinolaryngol 30(97):85–90PubMedCentralPubMed

36.

Sessoms PH, Gottshall KR, Collins JD, Markham AE, Service KA, Reini SA (2015) Improvements in gait speed and weight shift of persons with traumatic brain injury and vestibular dysfunction using a virtual reality computer-assisted rehabilitation environment. Mil Med 180(3 Suppl):143–149. https://doi.org/10.7205/milmed-d-14-00385CrossRefPubMed

37.

Scherer MR, Burrows H, Pinto R, Littlefield P, French LM, Tarbett AK, Schubert MC (2011) Evidence of central and peripheral vestibular pathology in blast-related traumatic brain injury. Otol Neurotol 32(4):571–580. https://doi.org/10.1097/MAO.0b013e318210b8faCrossRefPubMed

38.

Basta D, Todt I, Scherer H, Clarke A, Ernst A (2005) Postural control in otolith disorders. Hum Mov Sci 24(2):268–279. https://doi.org/10.1016/j.humov.2005.04.002CrossRefPubMed

39.

Basta D, Clarke A, Ernst A, Todt I (2007) Stance performance under different sensorimotor conditions in patients with post-traumatic otolith disorders. J Vestib Res Equilib Orient 17(1):25–31CrossRef

40.

Murray KJ, Hill KD, Phillips B, Waterston J (2007) The influence of otolith dysfunction on the clinical presentation of people with a peripheral vestibular disorder. Phys Ther 87(2):143–152. https://doi.org/10.2522/ptj.20060004CrossRefPubMed

41.

Longridge NS, Mallinson AI (2005) “Across the board” posturography abnormalities in vestibular injury. Otol Neurotol 26(4):695–698CrossRefPubMed

42.

Fife TD, Kalra D (2015) Persistent vertigo and dizziness after mild traumatic brain injury. Ann N Y Acad Sci 1343:97–105. https://doi.org/10.1111/nyas.12678CrossRefPubMed

Titel: Vestibular Assessment in Patients with Persistent Symptoms of Mild Traumatic Brain Injury
verfasst von: Sadegh Jafarzadeh
Akram Pourbakht
Eshagh Bahrami
Publikationsdatum: 17.08.2020
Verlag: Springer India
Erschienen in: Indian Journal of Otolaryngology and Head & Neck Surgery / Ausgabe Sonderheft 1/2022
Print ISSN: 2231-3796
Elektronische ISSN: 0973-7707
DOI: https://doi.org/10.1007/s12070-020-02043-0

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Vestibular Assessment in Patients with Persistent Symptoms of Mild Traumatic Brain Injury

Abstract