TBI
define TBI
brain damage due to an external mechanical force
what can TBI do to ears
cause HL, balance difficulties, central auditory disorders
test strategies to use with TBI pts
streamline testing
identify and prioritize info sought
model behaviors, simplify communication
adapt tests as needed
audiology part of AIED
hearing test
immittance
OAE
refer for ABR sometimes (can lead to imaging)
causes of TBI
blast waves
impact
projectile
acceleration/deceleration
TBI and dizziness/tinnitus
1/2 experience dizziness
can experience tinnitus
how to prioritize and identify info sought
transducer type
SRTs
AC/BC fewer frequencies (order, which ear)
objective measures (tymps, reflexes maybe, OAEs)
lab tests for AIED because
need to rule out syphilis
diffuse injury
generalized damage from stretching neuronal fibers that connect different brain regions
what type of HL does TBI cause
CHL or SNHL
summarize autoimmune inner ear disease
immune system mistakenly attacks part of body as foreign
antigen: substance that induces an immune response
may be organ specific (start in inner ear) or non-organ specific (start outside of IE)
IE can produce autoimmune response to sensitized cells that can enter cochlea from circulatory system
asymmetric SNHL bilaterally that progresses over weeks or months
meds reactions
one month high dose steroids while waiting on lab test results
focal injury
localized, often in frontal or temporal lobes
common peripheral sites of ear injury
TM, middle ear, cochlea
may displace/damage oval window, round window, basilar membrane (but we won't know)
symptoms and findings
HL, time, age range, dizziness and systemic immune disease, otoscopy and ear exam
asymmetrical bilateral SNHL that may fluctuate or progress
time: sudden onset, rapid time course (weeks/months)
primary age range: 20-50 years
1/2 report dizziness
1/3 have systemic immune disease
normal otoscopy and ear exam
AIED considerations
pts are fearful
inital hearing test shows idiopathic progressive SNHL
serial hearing tests are essential
may be candidate for amplification
monitor amplification since SNHL fluctuates
will need frequent visits
no definitive lab test
pts treated successfully may not have hearing restored
examples of diffuse injuries
edema (swelling), contusions (bruising), hemorrhage (bleeding)
personality changes after TBI (7)
anger management
impulse control
anxiety
depression
impaired social and coping skills
apathy
reduced self esteem
medical workup for AIED suspected
case hx, otologic exam
audiology
lab tests
evaluate clinical symptoms
determine medical reactions