Contralateral Labyrinthine Concussion in Temporal Bone Fractures

Abstract

In this case presentation, three cases of labyrinthine concussion in the opposite ears of patients who had unilateral traumatic temporal bone fractures with facial paralysis are reported. The first patient was a 30-year-old male who had a right-sided longitudinal temporal bone fracture and labyrinthine concussion showing pure sensorineural hearing loss with a characteristic notch of 60 dB at 4000 Hz on the left side. The second patient was a 42-year-old male who had a right-sided traumatic facial paralysis owing to a mixedtype temporal bone fracture and labyrinthine concussion, demonstrating pure sensorineural hearing loss reaching its peak of 50 dB at 4000 Hz on the left. The third patient was a 19-year-old male who had a left-sided mixed-type temporal bone fracture and a right labyrinthine concussion exhibiting pure sensorineural hearing loss reaching 60 dB at 4000 Hz. For their facial paralyses, all three patients underwent middle cranial fossa or combined approach operations. The labyrinthine concussion in these patients was managed expectantly. At their 1-year follow-up, it was observed that the hearing loss owing to labyrinthine concussion persisted. Although labyrinthine concussion is not a rare complication of head injuries, it has rarely been reported in the medical literature. The main symptoms of labyrinthine concussion are hearing loss, tinnitus, and dizziness. The diagnosis mainly relies on audiometric tests, which reveal characteristic tracings reminiscent of acoustic trauma. SOMMAIRE Nous rapportons ici le cas de trois patients ayant subi une fracture unilaterale de I'os temporal causant une paralysie faciale et chez qui nous avons aussi diagnostique une commotion labyrinthine contralaterale. Les trois patients ont du subir une operation par approche de la fosse moyenne ou par approche combinee. La commotion labyrinthique a ete traitee de fa^on conservatrice chez ces patients. La surdite persistait a la visite annuelle. Bien que la commotion labyrinthique ne soit pas une complication rare du trauma cranien, elle n'est que rarement discutee dans la litterature scientifique. Les principaux symptomes sont une surdite, un acouphene et un etourdissement. Le diagnostic repose sur I'audiologie qui montre un trace qui rappelle le trauma acoustique.Key words: hearing loss, labyrinthine concussion, temporal bone trauma r he term labyrinthine concussion is used to describe high-frequency sensorineural hearing loss with or without vestibular symptoms following head trauma without a demonstrable labyrinthine fracture. The symptoms of labyrinthine concussion are sensorineural hearing loss with a characteristic notch in the 4 to 6 kHz range resembling acoustic trauma, tinnitus, and positional vertigo.' Although labyrinthine concussion is not a rare complication of head injuries, it has rarely been reported in the medical literature.In this case presentation, three cases of labyrinthine concussion in the opposite ears of patients who were treated surgically for traumatic temporal bone fractures resulting in facial...

Clinical Characteristics of Labyrinthine Concussion

“…Ulug and Ulubil4) reported three patients with contra-lateral labyrinthine concussion in unilateral temporal bone fracture, and conjectured that high pressure waves caused by a severe blow to the head are directly transmitted to the cochlea by bone conduction, very similar to acoustic trauma. Ulug's case report shows the similarity to result of this study, high frequency hearing loss of unaffected ear in unilateral hearing loss patients.…”

“…This such clinical entity is described as labyrinthine concussion previously, and it is defined as high frequency sensorineural hearing loss with or without vestibular symptoms following head trauma without a definite labyrinthine fracture 3). This type of hearing loss also termed inner ear concussion, commotion labyrinthitis, and otitis interna vasomotoria 4). Although various studies have tried to explain the hearing loss that appears after head trauma, the mechanism of injury is not clear 5-8)…”

Ipsilateral facial nerve injury with contralateral labyrinthine concussion and subdural hematoma in a case of longitudinal temporal bone fracture

“…Labyrinthine concussion can be confirmed mainly by audiometric tests. 2 The PTA can reveal the type and severity of hearing loss. BSER may locate the level of involvement in the auditory pathway.…”

Posttraumatische Hörstörungen

“…die akustisch-mechanische Überstimulation (akustisches Trauma), was in beiden Fällen zu einem Funktionsverlust der Haarsinneszellen führt [18,19,21]. Dafür spricht auch, dass es kontralateral einer laterobasalen Fraktur durch die sich intrazerebral ausbreitende Druckwelle zu einer akuten Ertaubung kommen kann [29]. Das gilt in gleicher Weise für den Tinnitus.…”

“…Hörstörungen sind nach Unfällen, insbesondere nach Schädel-Hirn-Traumen (SHT), keine Seltenheit [5,13] betreffen, hinterlassen, ist die Kausalität meist gut belegt [6,29]. Knöcherne Veränderungen werden am besten mit einem hochauflösenden Felsenbein-CT (CT: Computertomographie), die anderen Veränderungen mit einem MRT (Magnetresonanztomographie) oder einer MR-Angiographie des Schädels festgestellt [6].…”