Head Injury: Some Otoneurologic Sequelae

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Abstract
Sixty-four patients with head injury received otoneurological review at a mean time of 24 months postinjury. Lateral head blows caused homolateral or bilateral cochlear loss and vestibular lesions that might be bilateral, homolateral, or contralateral alone. Tinnitus was usually homolateral alone. A lateral oblique head blow gave bilateral cochlear loss with the contralateral loss considerably greater than the homolateral. Significant cochlear and vestibular losses occurred regardless of severity of head injury. Psychiatric and intellectual defects were much more frequent in severe than in minor injuries and were much more important than cochlear or vestibular disorders in delaying recovery. Hearing losses at 4,000 and 8,000 Hz were present in 100 ears; the loss at 8,000 Hz exceeded that at 4,000 Hz in about half. The finding appeared not to be related to presbycusis. However, normal hearing at 4,000 Hz may occur even after severe head injury. Postural vertigo is common after head injury, but if it is episodic and accompanied by fluctuating and progressive hearing loss, traumatic perilymphatic fistula should be suspected and tympanotomy performed.

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