Symptom Complaints Following Reports of Blast Versus Non-Blast Mild TBI: Does Mechanism of Injury Matter?

Belanger, Heather G.; Proctor-Weber, Zoë; Kretzmer, Tracy; Kim, Michelle; French, Louis M.; Vanderploeg, Rodney D.

doi:10.1080/13854046.2011.566892

Cited by 117 publications

(99 citation statements)

References 44 publications

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“…29,30,53,54 Tinnitus was associated with TBI characteristics. Consistent with prior cross-sectional studies showing higher rates of tinnitus 20 and hearing problems 28 following blast versus nonblast injuries, postdeployment tinnitus was nearly twice as likely for those with nonblast TBI and nearly 3 times as likely for those with blast TBI compared with those with no TBI. In addition, tinnitus was 1.8 times as likely after a single TBI and 2.3 times as likely after multiple TBIs compared with tinnitus occurrence in those with no TBI.…”

Section: Discussionsupporting

confidence: 77%

“…25 This shearing force directly injures the brain and cochlea, causing an inflammatory response, oxidative stress-induced neural degeneration, 26 and subsequent neural alteration both within the cochlea and its auditory pathway. 27 Establishing a direct, causal link between blast exposure and tinnitus has been limited by the retrospective, cross-sectional nature of available accounts [28][29][30] and the existence of comorbid psychiatric disorders such as posttraumatic stress disorder (PTSD). 31,32 Failure to differentiate tinnitus symptoms from these comorbidities further hinders the identification of tinnitus-specific treatment modalities.…”

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confidence: 99%

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Prospective Associations Between Traumatic Brain Injury and Postdeployment Tinnitus in Active-Duty Marines

Yurgil¹,

Clifford²,

Risbrough³

et al. 2016

Journal of Head Trauma Rehabilitation

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Objective: To examine whether cause, severity, and frequency of traumatic brain injury (TBI) increase risk of postdeployment tinnitus when accounting for comorbid posttraumatic stress disorder. Design: Self-report and clinical assessments were done before and after an "index" deployment to Iraq or Afghanistan. Likelihood of new-onset postdeployment tinnitus was highest for those who were blast-exposed (OR = 2.93; 95% CI, 1.82-6.17), who reported moderatesevere TBI symptoms (OR = 2.22; 95% CI, 1.22-3.40), and who sustained multiple TBIs across study visits (OR = 2.27; 95% CI, 1.44-4.24). Posttraumatic stress disorder had no effect on tinnitus outcome. Conclusions: Participants who were blast-exposed, sustained multiple TBIs, and reported moderate-severe TBI symptoms were most at risk for new-onset tinnitus.

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Section: Discussionsupporting

confidence: 77%

mentioning

confidence: 99%

Prospective Associations Between Traumatic Brain Injury and Postdeployment Tinnitus in Active-Duty Marines

Yurgil¹,

Clifford²,

Risbrough³

et al. 2016

Journal of Head Trauma Rehabilitation

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“…For the milTBI group, five participants (24% of the sample) had been exposed to a single blast event, 8 (38%) reported two blast exposures, and the remaining eight (38%) reported multiple blast exposures (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. For the civTBI group, six (29%) participants had a history of a single concussion, five (24%) reported two concussions, and eight (38%) reported multiple concussions (range 3-10; data on additional concussions were not available for two participants in this group).…”

Section: Resultsmentioning

confidence: 99%

“…Although we have observed subtle differences in cognitive performance in blast-related TBI, 19 the cognitive deficits observed in the acute and subacute stage of mild to moderate TBI typically resolve in the chronic stage. Belanger and associates 20 have suggested that any differences between blast-related and mechanical TBI are likely the result of increased levels of psychological distress in blast-related TBI rather than any unique differences in brain pathology. An alternative strategy for differentiating blast-related from mechanical TBI is to identify unique neural signatures in brain activation patterns using functional magnetic resonance imaging (fMRI).…”

Section: T Raumatic Brain Injury (Tbi) Is Common In Military Personnementioning

confidence: 99%

Neural Activation during Response Inhibition Differentiates Blast from Mechanical Causes of Mild to Moderate Traumatic Brain Injury

Fischer

Parsons

Durgerian

et al. 2014

Journal of Neurotrauma

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Military personnel involved in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) commonly experience blastinduced mild to moderate traumatic brain injury (TBI). In this study, we used task-activated functional MRI (fMRI) to determine if blast-related TBI has a differential impact on brain activation in comparison with TBI caused primarily by mechanical forces in civilian settings. Four groups participated: (1) blast-related military TBI (milTBI; n = 21); (2) military controls (milCON; n = 22); (3) non-blast civilian TBI (civTBI; n = 21); and (4) civilian controls (civCON; n = 23) with orthopedic injuries. Mild to moderate TBI (MTBI) occurred 1 to 6 years before enrollment. Participants completed the Stop Signal Task (SST), a measure of inhibitory control, while undergoing fMRI. Brain activation was evaluated with 2 (mil, civ) · 2 (TBI, CON) analyses of variance, corrected for multiple comparisons. During correct inhibitions, fMRI activation was lower in the TBI than CON subjects in regions commonly associated with inhibitory control and the default mode network. In contrast, inhibitory failures showed significant interaction effects in the bilateral inferior temporal, left superior temporal, caudate, and cerebellar regions. Specifically, the milTBI group demonstrated more activation than the milCON group when failing to inhibit; in contrast, the civTBI group exhibited less activation than the civCON group. Covariance analyses controlling for the effects of education and selfreported psychological symptoms did not alter the brain activation findings. These results indicate that the chronic effects of TBI are associated with abnormal brain activation during successful response inhibition. During failed inhibition, the pattern of activation distinguished military from civilian TBI, suggesting that blast-related TBI has a unique effect on brain function that can be distinguished from TBI resulting from mechanical forces associated with sports or motor vehicle accidents. The implications of these findings for diagnosis and treatment of TBI are discussed.

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“…Some authors have concluded that these auditory complaints reflect symptoms primarily associated with posttraumatic stress disorder (PTSD) [15], while others suggest they are associated with blastrelated TBI [16], and more specifically, blast-related damage to the central auditory system [11][12][17][18]. The proposed mechanism for such damage is that a primary blast injury leads to contusions from the brain moving within skull, hemorrhaging from the tearing of surface veins, and diffuse axonal injury as neurons are sheared and stretched in the lower-and mid-brainstem nuclei, thalamus, and corpus callosum and synaptic structures connecting nuclei within the central auditory system [6,[19][20], which in turn negatively affects auditory and speech processing [18].…”

Section: Introductionmentioning

confidence: 99%

Auditory difficulties in blast-exposed Veterans with clinically normal hearing

et al. 2015

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Abstract-Vast numbers of blast-injured Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn personnel report postconcussive symptoms that include headache, dizziness, poor memory, and difficulty concentrating. In addition, many report hearing problems, such as difficulty understanding speech in noise, yet have no measureable peripheral auditory deficits. In this article, self-report and performancebased measures were used to assess 99 blast-exposed Veterans. All participants reported auditory problems in difficult listening situations but had clinically normal hearing. Participants' scores on self-report questionnaires of auditory difficulties were more similar to scores of older individuals with hearing impairment than to those of younger individuals with normal hearing. Participants showed deficits relative to published normative data on a number of performance-based tests that have demonstrated sensitivity to auditory processing deficits. There were several measures on which more than the expected number of participants (15.9%) performed one or more standard deviations below the mean. These were assessments of speech understanding in noise, binaural processing, temporal resolution, and speech segregation. Performance was not universally poor, with approximately 53% of participants performing abnormally on between 3 and 6 of the 10 measures. We concluded that participants exhibited task-specific deficits that add to the evidence suggesting that blast injury results in damage to the central auditory system. Clinical

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Symptom Complaints Following Reports of Blast Versus Non-Blast Mild TBI: Does Mechanism of Injury Matter?

Cited by 117 publications

References 44 publications

Prospective Associations Between Traumatic Brain Injury and Postdeployment Tinnitus in Active-Duty Marines

Prospective Associations Between Traumatic Brain Injury and Postdeployment Tinnitus in Active-Duty Marines

Neural Activation during Response Inhibition Differentiates Blast from Mechanical Causes of Mild to Moderate Traumatic Brain Injury

Auditory difficulties in blast-exposed Veterans with clinically normal hearing

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