Management of Posttraumatic Vertigo

Ernst, Arne; Basta, Dietmar; Seidl, Rainer; Todt, Ingo; Scherer, Hans; Clarke, A. H.

doi:10.1016/j.otohns.2004.09.034

Cited by 125 publications

(78 citation statements)

References 21 publications

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“…The neuroanatomical circuitry mediating vestibulo-ocular function consists of a rich network of complex special sense organs and primary processing units that share rich direct, indirect, and reciprocal projections to the spinal cord, autonomic nervous system, brainstem nuclei, cerebellum, thalamus, basal ganglia, and cerebral cortex. 25 Although physical examination can offer insight into the level at which dysfunction occurs within this neurological subsystem, 39 it remains unclear whether VOD is mediated by concussive damage to peripheral structures 14 or is a result of ongoing impairments in cellular metabolism and cerebral blood flow regulation affecting the CNS. 15,31,38 Without a clear understanding of the pathophysiological mechanisms mediating vestibular and oculomotor symptoms, it is difficult to evaluate the benefit of rehabilitation strategies such as vestibular physiotherapy that were used in this study.…”

Section: Discussionmentioning

confidence: 99%

Vestibulo-ocular dysfunction in pediatric sports-related concussion

Ellis

Cordingley

Vis

et al. 2015

PED

147

130

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OBJECT The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. METHODS The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. RESULTS A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5–54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13–32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04–16.16). CONCLUSIONS Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort.

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Section: Discussionmentioning

confidence: 99%

Vestibulo-ocular dysfunction in pediatric sports-related concussion

Ellis

Cordingley

Vis

et al. 2015

PED

147

130

View full text Add to dashboard Cite

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“…Since the patients in our study were usually referred from other departments, they had complained of dizziness for over 1 month. Ernst et al [4] noted that labyrinthine concussion usually normalized within 5 days, while cervicogenic vertigo and otolith disorders were diagnosed at an average of 6 weeks after the trauma. Therefore, our patients who complained of dizziness likely had cervicogenic vertigo or otolith disorders.…”

Section: Discussionmentioning

confidence: 99%

“…The brain, inner ear and cervical spine are all at risk of trauma, and injuries to any or all may lead to difficulties in balance [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Otolith disorders after head trauma can occur as isolated disorder and they were frequently undetectable in the past [4]. More recently, otolith function test such as vestibular evoked myogenic potentials (VEMP) and subjective visual vertical (SVV) have been used as specific diagnostic tools for the investigation of saccular and utricular function.…”

Section: Introductionmentioning

confidence: 99%

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Otolith function in patients with head trauma

Lee

Park

Lee

et al. 2011

Eur Arch Otorhinolaryngol

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This study evaluates the otolith function of patients with head trauma, postulating that otolith dysfunction is a cause of nonspecific dizziness after head trauma. We prospectively enrolled 28 patients referred within 3 months after head trauma between March 2007 and December 2009. Pure tone audiometry, caloric testing and otolith function tests, including cervical vestibular evoked myogenic potential (cVEMP) and subjective visual vertical (SVV) tests, were performed on all patients. The relationship between otolith function and otologic symptoms was analyzed. Of the 28 patients with head trauma, 18 complained of dizziness and 12 experienced hearing loss, including 6 patients who complained of both. On defining otolith dysfunction as an abnormal cVEMP or abnormal SVV, a significant difference in otolith dysfunction existed between the groups with and without dizziness [72 (13/18) vs. 20% (2/10)]. In contrast, no significant difference in otolith dysfunction was detected between the abnormal and normal hearing groups. A significant number of the patients who complained of nonspecific dizziness after trauma had abnormal otolith function. After trauma, when patients complain of dizziness, vestibular function tests, including otolith function tests, should be considered.

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“…Trauma of the head, neck, and craniocervical junction can have a major impact on the brainstem, the cerebellum or the vestibular system at various sites, such as the semicircular canals, the vestibule, or the vestibular nerve, and thereby induce vertigo [33]. If vertigo is induced by posttraumatic perilymphatic fistula, surgery can be performed to correct the symptoms [34,35].…”

Section: Vertigomentioning

confidence: 99%

Risk of Ear-Associated Diseases After Zygomaticomaxillary Complex Fracture

Yang

Tai

Chien

et al. 2015

J. Maxillofac. Oral Surg.

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Purpose Investigate the risk of ear-associated diseases after zygomaticomaxillary complex (ZMC) fracture in a population-based retrospective cohort study. Materials and Methods This is a retrospective cohort study using Taiwan's National Health Insurance Research Database of reimbursement claims. A total of 1,330 ZMC fracture patients and 5,320 non-ZMC fracture participants were included and newly developed ear-associated disease data were collected. A Poisson regression and multivariate Cox proportion hazard regression were used for data analysis. Results The ZMC fracture cohort had a higher incidence of tinnitus than non-ZMC fracture cohort (IRR 1.64, 95 % CI 1.37-1.96), particularly in younger patients (B34 years of age; IRR 4.05, 95 % CI 3.18-5.15) and male patients (IRR 2.08, 95 % CI 1.12-3.73). ZMC fracture patients also showed a significantly increased risk of having trigeminal neuralgia [IRR 4.06, 95 % CI 3.34-4.94, adjusted HR 4.07 (1.02-16.3)]. For sudden hearing loss and peripheral vertigo, the incidence densities were higher in the ZMC fracture cohort, but these relationships were not significant in the multivariate Cox proportional hazard regression analyses (HR 2.69, 95 % CI 0.76-9.53 for risk of sudden hearing loss; HR 1.36, 95 % CI 0.77-2.40 for risk of peripheral vertigo). Conclusions The findings of the study suggest an increased risk of ear-associated diseases among individuals with ZMC fractures, particularly within 2-years follow-ups after injury. We suggest performing detailed examinations for ear-associated diseases in patients with ZMC fractures for early diagnosis and adequate treatment.Chao-Chih Yang and Chih-Jaan Tai have contributed equally to this work.

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Management of Posttraumatic Vertigo

Abstract: Minor trauma of the head, neck, and craniocervical junction can have major impact on the vestibular system at different sites. Patients need to be carefully diagnosed, even if the onset of vertigo occurs a few weeks or months after the initial trauma.

Cited by 125 publications

References 21 publications

Vestibulo-ocular dysfunction in pediatric sports-related concussion

Vestibulo-ocular dysfunction in pediatric sports-related concussion

Otolith function in patients with head trauma

Risk of Ear-Associated Diseases After Zygomaticomaxillary Complex Fracture

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