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Audiologic and cognitive long-term sequelae from closed head injury
Örebro University, Department of Nursing and Caring Sciences.
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
Keyword [en]
History of medicine, Closed head injury, CHI, sensorineural hearing loss, SNHL, cognition, TIPS, tinnitus, vertigo, memory, quality of life, QOL, Gothenburg profile
Keyword [sv]
Medicinhistoria
National Category
History
Research subject
Medical Disability Research
Identifiers
URN: urn:nbn:se:oru:diva-67ISBN: 91-7668-384-2 (print)OAI: oai:DiVA.org:oru-67DiVA, id: diva2:137099
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
List of papers
1. Long-term objective and subjective audiologic consequences of closed head injury
Open this publication in new window or tab >>Long-term objective and subjective audiologic consequences of closed head injury
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.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3133 (URN)10.1080/00016480152583674 (DOI)11678172 (PubMedID)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14Bibliographically approved
2. Progressive hearing loss after closed head injury: a predictable outcome?
Open this publication in new window or tab >>Progressive hearing loss after closed head injury: a predictable outcome?
2003 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 123, no 7, p. 836-845Article in journal (Refereed) Published
Abstract [en]

Objectives-To evaluate the prevalence of progression of closed head injury (CHI)-induced hearing impairment, defined as greater than or equal to 15 dB HL deterioration at 1 or more frequencies, and to identify risk factors in patient history and initial status that could predict progression.

Material and Methods-A total of 600 patients with major CHI were admitted to 2 Swedish medical centres during a 14-year period. The type of injury was established by means of CT and the severity of head injury was measured using the Swedish Reaction Level Scale (RLS). In 62 of these patients, pure-tone audiometry was performed soon after the injury. Forty-three patients agreed to participate in the present investigation, which was carried out 2-13 years after the injury. Each participant was evaluated using pure-tone audiometry and an itemized anamnesis was obtained.

Results-There was a higher prevalence of hearing impairments in the study group compared to a control group. Thirty-two subjects (74%) showed a progression of greater than or equal to 15 dB, which was significantly greater than the spontaneous progression in the control group. Age and temporal bone fracture were risk factors for progression but not brain contusion only or RLS. There was an association between early pure-tone average (PTA) and progression as well as regression, i.e. the poorer the initial PTA the greater the progression as well as regression, indicating increased instability in the auditory system. Examination of patient histories did not reveal any single risk factors for progression. A serendipitous finding was a higher prevalence of reported memory shortcomings among those with post-traumatic tinnitus.

Conclusion-Especially for those with fracture of the temporal bone the present results stress the importance of audiometric evaluation and follow-up, from both rehabilitation and medicolegal perspectives

National Category
Medical and Health Sciences Otorhinolaryngology
Research subject
Medical Disability Research
Identifiers
urn:nbn:se:oru:diva-3134 (URN)10.1080/00016480310002474 (DOI)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14Bibliographically approved
3. Progress of sensorineural hearing loss after closed head injury: presence of autoantibodies
Open this publication in new window or tab >>Progress of sensorineural hearing loss after closed head injury: presence of autoantibodies
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
National Category
Medical and Health Sciences Otorhinolaryngology
Research subject
Medical Disability Research
Identifiers
urn:nbn:se:oru:diva-3135 (URN)10.1080/16513860410031966 (DOI)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14Bibliographically approved
4. Appearances are deceptive?: Long-term cognitive and central auditory sequelae from closed head injury
Open this publication in new window or tab >>Appearances are deceptive?: Long-term cognitive and central auditory sequelae from closed head injury
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.

National Category
Medical and Health Sciences Otorhinolaryngology
Research subject
Medical Disability Research
Identifiers
urn:nbn:se:oru:diva-3136 (URN)10.1080/14992020400022546 (DOI)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14Bibliographically approved
5. Long-term sequelae of closed head injury: disability, handicap & quality of life
Open this publication in new window or tab >>Long-term sequelae of closed head injury: disability, handicap & quality of life
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Medical Disability Research
Identifiers
urn:nbn:se:oru:diva-3137 (URN)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-10-18Bibliographically approved

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