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Appearances are deceptive?: Long-term cognitive and central auditory sequelae from closed head injury
Örebro University, Department of Nursing and Caring Sciences.
2005 (English)In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 44, no 1, p. 39-49Article in journal (Refereed) Published
Abstract [en]

The purpose of the present study was to examine possible signs of long-term cognitive and/or central auditory sequelae seven to eleven years after a closed head injury (CHI) of sufficient severity to cause scull fracture and/or brain contusion. Another purpose was that this investigation should be carried out in a group of recovered trauma victims with, to the individual, no known or minimal sequelae. A computer-based set of five cognitive tests and three central auditory tests were used in a group of formerly brain-injured patients who considered themselves as well recovered. Most of the participants did not report any signs of cognitive or auditory impairment. Tests of working memory capacity, verbal information processing speed, phonological processing and verbal inference-making ability were used. Auditory brain response (ABR), distorted speech audiometry (interrupted speech), and phase audiometry were used to test central auditory function. The initial severity of brain damage, i.e. status when the patient arrived at the emergency ward, was estimated with Swedish Reaction Level Scale (RLS). Cognitive shortcomings after CHI were demonstrated in a high percentage (59%, 13/22) of the cases seven to eleven years after the injury. Central auditory processing disorders (APD) were also demonstrated in a fairly high percentage (58%, 11/19) of the subjects. None of the correlations between RLS and the results on cognitive and central auditory tests reached statistical significance. However, there was a correlation between cognitive performance and the results on the central auditory tests used in this investigation. Eighty percent (8/10) of those participants with pathologies on ABR and/or phase audiometry and/or IS also failed on one or more of the cognitive tasks, compared to 44% (4/9) among those with no signs of APD. It is possible, many years after CHI, to observe cognitive shortcomings and APD in a relatively high percentage of CHI cases that are subjectively considered to be fairly well recovered. The cognitive tasks used in the study have proved to be a sensitive method to discover cognitive impairments. Long-term cognitive sequelae and APD could not be predicted from RLS scores.

Place, publisher, year, edition, pages
2005. Vol. 44, no 1, p. 39-49
National Category
Medical and Health Sciences Otorhinolaryngology
Research subject
Medical Disability Research
Identifiers
URN: urn:nbn:se:oru:diva-3136DOI: 10.1080/14992020400022546OAI: oai:DiVA.org:oru-3136DiVA, id: diva2:137097
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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