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Progress of sensorineural hearing loss after closed head injury: presence of autoantibodies
Örebro University, Department of Nursing and Caring Sciences.
2004 (English)In: Audiological Medicine, ISSN 1651-386X, E-ISSN 1651-3835, Vol. 2, no 2, p. 92-99Article in journal (Refereed) Published
Abstract [en]

Sensorineural hearing impairment is a common sequel to closed head injury (CHI). In most cases, the impairment subsides within the first post‐traumatic year; in some cases the impairment is permanent and in other cases there will be progress. In most cases the reason for progress is unknown. Substantial research has been carried out to ascertain the aetiology of sudden sensorineural hearing loss (SNHL) and Menière's disease. A number of studies have demonstrated the presence of antibodies against HSP 70 antigen in patients' sera. In accordance with this finding, autoimmunity as an aetiological factor for progressive SNHL has been proposed. There are reports indicating that trauma is a possible mechanism for eliciting an autoimmune response, and the aim of the present study is to study this mechanism. The question of sympathetic cochleolabyrinthitis is highlighted. Sera from 35 subjects with a history of closed head injury three to 13 years prior to the investigation were obtained for Western blot immunoassay in an attempt to identify HSP 70 antibodies. Twenty‐seven of the subjects demonstrated progress of a sensorineural hearing impairment after CHI. Two of 35, both with progress of a SNHL, demonstrated presence of anti‐HSP 70 antibodies. Therefore, a significant role of an HSP 70 related autoimmune mechanism for SNHL progress post CHI could not be confirmed in the present study. Nevertheless, the possible role of autoantibodies in individual cases cannot be ruled out, neither can the presence of other transitory autoimmune reactions after CHI. No conclusive evidence of sympathetic cochleolabyrinthitis was found.

Place, publisher, year, edition, pages
Informa healthcare , 2004. Vol. 2, no 2, p. 92-99
National Category
Medical and Health Sciences Otorhinolaryngology
Research subject
Medical Disability Research
Identifiers
URN: urn:nbn:se:oru:diva-3135DOI: 10.1080/16513860410031966OAI: oai:DiVA.org:oru-3135DiVA, id: diva2:137096
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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