Auditory function in acute severe head injury

Abstract

There are few clinical neuro‐otologic investigations of acute head injury. We obtained impedance and auditory brain stem response measures for 25 acute head‐injured patients, usually within 76 hours following injury. All patients were comatose at the time of assessment. Impedance abnormalities were found for over three‐fourths of the patients. Generally, they were associated with transient, reversible dysfunction, such as high negative middle ear pressure. The acoustic stapedius reflex, however, was seldom observed, even in patients with apparently normal middle ear function. Auditory brain stem response measures showed evidence of CNS dysfunction in 80% of the patients. Abnormalities ranged from prolonged latency and reduced amplitude of the wave V auditory brain stem response component to total absence of brain stem auditory activity. There was a relationship between auditory brain stem response findings and neurologic outcome at 1 month post assessment. Electrophysiologic auditory measures are clinically valuable in neuro‐otologic diagnosis and neurologic prognosis of acute, severe head injury.

Facial Nerve Palsy After Head Injury: Case Incidence, Causes, Clinical Profile and Outcome

“…For this reason, the Otologist should be involved in the management of the head injured as early as possible from the time of admission to the emergency unit. In severely head injured who cannot cooperate, brain stem evoked response audiometry can be helpful, 18 though this facility is not available in our center at the moment. Conductive hearing loss is much commoner because it can occur after less severe injuries and is often temporary and is related to hemotympanum or a lacerated drum.…”

Electrophysiological assessments of cognition and sensory processing in TBI: Applications for diagnosis, prognosis and rehabilitation

“…3 and Table 1). Hall et al (1982) reported the following relationships between ABR waveforms and functional outcome of the same patients one month later: These results indicate a correlation between ABR morphology soon after injury and neurologic functions one month later, although exceptions obviously exist for this group of 20 patients. This is one of many studies that used ABRs to assess comatose patients.…”

“…Auditory brainstem response (ABR) Hall et al (1982) recorded click-evoked ABRs (using a rate of 21 clicks/s) from 20 patients with severe TBI and compared their responses with ABRs from 15 control subjects. All TBI patients were comatose at the time ABRs were recorded, within 76 h post-injury.…”

“…When we next describe other investigations of this kind, it will become clear that ABR results are not consistent across studies. Part of the explanation for this variability can be found in the description provided by Hall et al (1982) of injuries suffered by their patients: The majority of patients were involved in motor vehicle accidents, but some were pedestrians, some were passengers, some were on motorcycles, and one was riding a bicycle. Other causes of head injury included gunshots, assaults, and falls.…”

Auditory Evoked Responses in Severe Head Injury

“…Auditory dysfunction, which may be a component of temporal bone fracture, can also occur in patients without evidence of fracture (Podoshin and Fradis, 1975). Trauma-related middle ear pathology is a common finding (Podoshin and Fradis, 1975;Hall et al, 1982). For the most part, these studies of peripheral auditory status following head injury were conducted on patients who showed good long-term neurological recovery, and could be assessed with traditional behavioral audiologic techniques.…”