Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury

Misale, Priyanka; Hassannia, Fatemeh; Dabiri, Sasan; Brandstaetter, Tom

doi:10.1038/s41598-021-02987-5

Cited by 10 publications

(19 citation statements)

References 43 publications

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“…Use of oVEMPs to test utricular dysfunction in TBI has rarely been reported. Campbell et al described asymmetrical oVEMPs in five of 29 (17%) of patients with chronic TBI, which was not significantly different from age-matched controls ( 31 ), whereas Misale et al reported abnormalities in 18 of 36 patients (50%) with TBI and non-positional, post-traumatic episodic vertigo ( 33 ).…”

Section: Discussionmentioning

confidence: 98%

“…Consistent with our findings, abnormality rates on either test are often < 25% with few reports of bilateral involvement ( 4 , 12 , 13 , 29 – 31 ). Three studies which included vertical canal vHIT showed increased detection rates with reports of abnormal function of at least one semicircular canal in 21.2–52% of patients ( 12 , 32 , 33 ). Otolith function has been mainly studied using cVEMPs with rates of saccular dysfunction ranging between 0 and 52% ( 7 , 12 , 13 , 29 , 31 , 33 – 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…Three studies which included vertical canal vHIT showed increased detection rates with reports of abnormal function of at least one semicircular canal in 21.2-52% of patients (12,32,33). Otolith function has been mainly studied using cVEMPs with rates of saccular dysfunction ranging between 0 and 52% (7,12,13,29,31,(33)(34)(35). Use of oVEMPs to test utricular dysfunction in TBI has rarely been reported.…”

Section: Discussion Prevalence and Patterns Of Peripheral Vestibular ...mentioning

confidence: 99%

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Patterns of vestibular dysfunction in chronic traumatic brain injury

et al. 2022

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BackgroundDizziness and imbalance are common following traumatic brain injury (TBI). While these symptoms are often attributed to vestibular dysfunction, the relative contribution of peripheral vs. central mechanisms is unclear. This study investigated the prevalence of semicircular canal and otolith abnormalities in a cohort of patients with chronic TBI and symptoms of dizziness or imbalance. The relationship between vestibular, oculomotor and posturography results was further explored.MethodsClinical records of patients attending the New Zealand Dizziness and Balance Centre from January 2015 to December 2019 were reviewed for consideration in the study. Inclusion required: an age of 18–80 years, a diagnosed TBI, and vestibular assessment using three-dimensional video head impulses (vHIT), cervical and ocular vestibular-evoked myogenic potentials (c and o VEMPs, respectively) and caloric testing. Severe TBI, pre-existing vestibular diagnoses, and incomplete test results were excluded. Rates of abnormalities were determined for each test and compared with results of oculomotor function testing and postural control, measured using the sensory organization test (SOT).ResultsOf 158 reviewed records, 99 patients aged 49 ± 15 years (59 female) fulfilled criteria for inclusion in the study. The median time between the head injury and the clinical assessment was 12 (IQR 6–21) months. Abnormalities involving one or more components of the vestibular labyrinth and/or nerve divisions were identified in 33 of 99 patients (33.3%). The horizontal semicircular canal was most frequently affected (18.2%), followed by the saccule (14.1%), utricle (8.1%), posterior (7.1%) and anterior (2.0%) semicircular canals. Vestibular test abnormalities were associated with skull-base fractures, superior canal dehiscence, and focal ear trauma. Oculomotor dysfunction and postural instability were recorded in 41.1 and 75.5% of patients, respectively. Postural instability correlated with abnormal oculomotor function (p = 0.008) but not peripheral vestibular hypofunction (p = 0.336).ConclusionsDizziness and/or imbalance in chronic TBI was associated with impaired postural stability for tasks requiring high levels of use of vestibular and visual input for balance. Vestibular hypofunction identified through vHIT, VEMP and caloric testing was recorded but was less common, except when the injury involved a fractured skull-base. There was no specific pattern of end-organ or nerve involvement which characterized this group of patients.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussion Prevalence and Patterns Of Peripheral Vestibular ...mentioning

confidence: 99%

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Patterns of vestibular dysfunction in chronic traumatic brain injury

et al. 2022

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“…Benign paroxysmal positional vertigo, labyrinthine concussion, and vestibular migraine are the most common etiologies of peripheral vestibular system disorders reported after mTBI [ 25 ]. Direct vestibular nerve or labyrinth injury resulting from petrous bone fracture, potentially generating a perilymphatic fistula, has also been associated with CCT to a lesser extent [ 70 71 ]. More recently, a case series pointed out that CCT may also potentiate superior semicircular canal dehiscence syndrome [ 72 ].…”

Section: Post Traumatic Craniocervical Disorders Reviewed From a Post...mentioning

confidence: 99%

Post-Traumatic Craniocervical Disorders From a Postural Control Perspective: A Narrative Review

Belhassen,

Mat,

Ferret

et al. 2023

Brain Neurorehabil

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Mild traumatic brain injury (mTBI) and whiplash injury (WI) may lead to long-term disabling consequences known as post-concussive syndrome (PCS) and whiplash-associated disorders (WADs). PCS and WAD patients commonly complain of conditions encompassing dizziness, vertigo, headache, neck pain, visual complaints, anxiety, and neurocognitive dysfunctions. A proper medical work-up is a priority in order to rule out any acute treatable consequences. However investigations may remain poorly conclusive. Gathered in the head and neck structures, the ocular sensorimotor, the vestibular, and the cervical proprioceptive systems, all involved in postural control, may be damaged by mTBI or WI. Their dysfunctions are associated with a wide range of functional disorders including symptoms reported by PCS and WAD patients. In addition, the stomatognathic system needs to be specifically assessed particularly when associated to WI. Evidence for considering the post-traumatic impairment of these systems in PCS and WAD-related symptoms is still lacking but seems promising. Furthermore, few studies have considered the assessment and/or treatment of these widely interconnected systems from a comprehensive perspective. We argue that further research focusing on consequences of mTBI and WI on the systems involved in the postural control are necessary in order to bring new perspective of treatment.

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“…There is evidence that these systems are often affected in the acute phase after mmTBI [ 8 , 9 ]. In the chronic phase after mmTBI, failure to compensate for a peripheral vestibular disruption may cause persistent dizziness [ 10 ]. A recent study by Campbell et al [ 11 ] found that persisting dizziness and balance problems after mmTBI can be explained by dysfunction in central sensory integration rather than dysfunction in the peripheral vestibular or oculomotor systems.…”

Section: Introductionmentioning

confidence: 99%

Dizziness-Related Disability One Year after a Mild-to-Moderate TBI—A Follow-Up Study

Kleffelgård

Anđelić

Bruusgaard

et al. 2023

JCM

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Persisting dizziness and balance problems after mild-to-moderate traumatic brain injury (mmTBI) may result in considerable disability. The primary aim of this study was to explore the factors associated with dizziness-related disability one year post-injury. Data from 64 participants (mean age 39.4 [SD 13.0] years; 45 [70.3%] women) with mmTBI from a previous randomised controlled trial were analysed using simple and multiple regression analyses (Clinical Trials Registry #NCT01695577). The Dizziness Handicap Inventory one year (12.1, [SD1.6] months) post-injury was the dependent variable. Demographic and injury-related variables, clinical findings, and measures of post-injury symptoms and functioning (Rivermead Post-Concussion Symptoms Questionnaire, RPQ; Vertigo Symptom Scale-short form, VSS-SF; Hospital Anxiety and Depression Scale; Balance Error Scoring System; and High-Level Mobility Assessment Tool, HiMAT) at baseline (3.5 [SD 2.1] months post-injury) were the independent variables. Dizziness-related disability at one year was associated with pre-injury comorbidity, neck pain, higher RPQ, higher VSS-SF, and lower HiMAT scores (adjusted R2 = 0.370, F = 6.52 p < 0.001). In conclusion, the factors associated with dizziness-related disability one year post-injury, such as pre-injury comorbidity, neck pain, increased post-concussion symptom burden, increased dizziness symptom severity, and reduced balance and mobility, should be addressed early in the rehabilitation process to reduce patient burden.

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Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury

Cited by 10 publications

References 43 publications

Patterns of vestibular dysfunction in chronic traumatic brain injury

Patterns of vestibular dysfunction in chronic traumatic brain injury

Post-Traumatic Craniocervical Disorders From a Postural Control Perspective: A Narrative Review

Dizziness-Related Disability One Year after a Mild-to-Moderate TBI—A Follow-Up Study

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