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Long-term objective and subjective audiologic consequences of closed head injury
Örebro University, Department of Nursing and Caring Sciences.
2001 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 121, no 6, p. 724-734Article in journal (Refereed) Published
Abstract [en]

During a period of 5 years, a total of 47 patients, 16-60 years of age, with major closed head injury (CHI) were admitted to 2 Swedish medical centres. Seven to 11 years after injury, 25 of them (mean age 40.8 years; range 25-59 years) were evaluated using peripheral and central auditory tests, and most of them also completed 2 questionnaires concerning self-assessed hearing ability and quality of life. Twenty-two patients did not participate in the long-term follow-up tests: 15 were excluded for medical reasons and 4 did not wish to participate; an additional 2 were impossible to trace and 1 had died. As many as 68% of patients (17/25) demonstrated abnormalities on 1 or more of the audiometric tests, 14 on pure-tone audiometry (p < 0.02) and/or central audiometric tests (3 on central tests only and 2 on pure-tone audiometry only). Four out of six patients with available early post-traumatic audiograms showed a significant progressive deterioration. As a group, their assessments of hearing ability and quality of life were equal to or better than those of the controls. These results may indicate that a higher priority should be given to obtaining an early audiologic evaluation of every CHI patient than is the rule today. The impact of post-traumatic progress and central lesions on social hearing at an advanced age is highlighted.

Place, publisher, year, edition, pages
2001. Vol. 121, no 6, p. 724-734
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-3133DOI: 10.1080/00016480152583674PubMedID: 11678172OAI: oai:DiVA.org:oru-3133DiVA, id: diva2:137094
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Audiologic and cognitive long-term sequelae from closed head injury
Open this publication in new window or tab >>Audiologic and cognitive long-term sequelae from closed head injury
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives – Head injury is an important health problem all over the world. Previous studies have shown that peripheral hearing impairment (HI) is a common sequel of closed head injury (CHI), but in most cases it will subside within the first posttraumatic months. However, in some cases, the HI persists and in other cases there can even be progress. The objective of the present study was to analyse long-term audiologic and cognitive consequences of CHI.

There were four main issues:

1. To study the presence and progress of sensorineural hearing loss (SNHL) after CHI and whether prediction of progress is possible. Autoimmunity as a possible cause of progress is also investigated, and the question of sympathetic cochleolabyrinthitis is discussed.

2. To study the presence of central auditory processing disorders (CAPD) after CHI; the question of a King-Kopetzky syndrome should be discussed.

3. To study the presence of cognitive impairments.

4. To evaluate self-assessed hearing, cognition and quality of life from a long-term perspective.

Material and methods – During a period of 14 years, around 2000 patients with head injuries were admitted to the emergency ward at Lindesberg County Hospital and Örebro Medical Centre Hospital. Six hundred subjects suffered from skull fracture and/or brain contusion and diagnosis was established using a computed tomography scan (CT). The degree of initial brain injury was estimated using the Swedish Reaction Level Scale (RLS). Sixty-six subjects were investigated with pure tone audiometry in close proximity to the trauma, and this gave an opportunity to study the issue of progress. The investigation took place two to 14 years after trauma, and the results were compared to matched control groups. A battery of different audiological methods was used to investigate peripheral and central auditory function, and a specially designed acoustic environmental room was also utilized. Cognition was investigated using a computer-based test-battery, text information process system (TIPS). Self-assessed hearing, cognition and quality of life were explored using different questionnaires.

Results – A high percentage of peripheral and central auditory impairments and also cognitive shortcomings were demonstrated. Progress of SNHL was a common finding, and fracture, high age at trauma and large initial hearing loss predicted progress. Antibody-mediated autoimmunity as a mechanism behind posttraumatic progress of SNHL or clear evidence for sympathetic cochleolabyrinthitis could not be demonstrated. Binaural auditory deficits could be demonstrated when tested in a realistic acoustic environment. Tinnitus, vertigo and memory shortcomings proved to be common sequelae, even in a long-term perspective

Cognitive shortcomings were found in several of these well-rehabilitated subjects.

On a group level, there was a good correlation between self-assessments and audiometric results, even if some individuals had a tendency to over- or underestimate their abilities.

Conclusion – Auditory and cognitive long-term sequelae of CHI are a common finding even in well-rehabilitated and socially well-functioning subjects, as are vertigo and tinnitus. Vertigo and tinnitus are also common sequelae after CHI, therefore a basic audiovestibular investigation after CHI is recommended, at least in selected cases.

Early awareness of the risk for hearing and cognitive sequelae after CHI could lead to measurements taken to prevent tension-related symptoms.

Early detection of HI offers an opportunity to try immunosuppressive treatment in cases with a large initial SNHL.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek, 2004. p. 87
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 1
Keywords
History of medicine, Closed head injury, CHI, sensorineural hearing loss, SNHL, cognition, TIPS, tinnitus, vertigo, memory, quality of life, QOL, Gothenburg profile, Medicinhistoria
National Category
History
Research subject
Medical Disability Research
Identifiers
urn:nbn:se:oru:diva-67 (URN)91-7668-384-2 (ISBN)
Public defence
2004-05-07, B-husets aula, Universitetssjukhuset i Örebro, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-10-18Bibliographically approved

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