Auditory and Cognitive Behavioral Performance Deficits and Symptom Reporting in Postconcussion Syndrome Following Mild Traumatic Brain Injury

Abstract

Purpose This study examined auditory deficits and symptom reporting in individuals with long-term postconcussion symptoms following a single mild traumatic brain injury (mTBI) compared to age- and gender-matched controls without a history of mTBI. Method Case history interviews, symptom questionnaires, and a battery of central auditory and neuropsychological tests were administered to 2 groups. The mTBI group was a civilian population recruited from a local concussion management program who were seeking rehabilitation for postconcussion-related problems in a postacute period between 3 and 18 months following injury. Symptom validity testing was included to assess the rate of possible insufficient test effort and its influence on scores for all outcome measures. Analyses of group differences in test scores were performed both with and without the participants who showed insufficient test effort. Rates of symptom reporting, correlations among symptoms and behavioral test outcomes, and the relationships between auditory and cognitive test performance were analyzed. Results The mTBI group reported a high rate of auditory symptoms and general postconcussion symptoms. Performance on neuropsychological tests of cognitive function showed some differences in raw scores between groups, but when effort was considered, there were no significant differences in the rate of abnormal performance between groups. In contrast, there were significant differences in both raw scores and the rate of abnormal performance between groups for some auditory tests when only considering participants with sufficient effort. Auditory symptoms were strongly correlated with other general postconcussion symptoms. Conclusions Significant auditory symptoms and evidence of long-term central auditory dysfunction were found in a subset of individuals who had chronic postconcussion symptoms after a single mTBI unrelated to blast trauma. The rate of abnormal performance on auditory behavioral tests exceeded the rate of abnormal performance on tests of cognitive function. Supplemental Material https://doi.org/10.23641/asha.8329955

Impaired auditory processing and neural representation of speech in noise among symptomatic post-concussion adults

“…Noise was detrimental to the waveforms representations of speech for both the mTBI and control groups, perhaps to the extent that group differences could not be detected. While performance on a cognitive test battery did not differ between groups in terms of the rate of abnormal scores, there were significant differences in raw scores on most of the measures [13]. It is possible this overall cognitive difference could account for the P300 group results.…”

“…Mean and standard deviation of raw scores on cognitive/neuropsychological and behavioral auditory tests and sub-tests for the control and mTBI groups and the number and percentage of scores in each group that were outside of criteria for normal performance. Full behavioral data appear in Vander Werff and Rieger [13]. Mean and standard deviation of individually picked peak amplitudes and latencies for each component by group and condition with results from the mixed model ANOVAS for the main effects of group (control vs. mTBI) and condition (quiet vs. noise) and the interaction.…”

“…A battery of behavioral tests of central auditory processing abilities and neuropsychological tests of cognitive performance were completed on all participants in both the mTBI and control groups. Detailed methods and results of these evaluations are presented in a companion paper [13], but a summary of raw scores and group outcomes for all cognitive and behavioral tests is shown in [61,62]. Four participants in the mTBI group failed the criteria for sufficient test effort on the MSVT.…”

“…The majority of participants were tested within 9 months of injury (mean 6.8 ± 4.0 months, median 5.1 months). Reported on-going symptoms were not required to be auditory in nature, and included physical symptoms such as headache, dizziness, light and sound sensitivities as well as poor concentration, irritability, fatigue, anxiety, and depression, rates of which are reported in Vander Werff and Rieger [13]. All were diagnosed with mTBI consistent with criteria from the American Congress of Rehabilitation Medicine [54].…”

“…Among the chronic problems, studies have documented auditory dysfunction following both nonblast and blast-related mTBI. Despite the fact that few of these individuals have hearing outside the normal range on a clinical audiogram, a significant percentage report difficulty understanding speech in background noise as well as difficulty on other complex auditory tasks, such as understanding rapid speech or detecting small gaps in noise [5][6][7][8][9][10][11][12][13]. Difficulties with these tasks may result from damage to structures in the central auditory pathway which may be especially vulnerable to mTBI, including auditory brainstem nuclei, structures in the left temporal lobe, pathways between the thalamus and primary auditory cortex, the planum temporale, and the corpus callosum [14][15][16].…”