I am a Physician my self who was involved in a MVA, with close head injury with a blowout fracture of left eye and total loss of vision in that eye. I did not notice hearing loss at first but about one week later every sound was garbled and it felt like I had a bad cold. Went to and ENT and was examined with audiogram which showed about 42db loss about the same in both ears which was slightly worse than a previous exam last year which I knew about and was told to get hearing aids. Well, since that time the hearing somewhat cleared over two weeks.
Then got worse again. Went back to Dr., Was put on nasal Steroids and Claritin D BID. Some virtigo with movement. Cleared up again. Obout one week later worse than ever. Sounds like a bad speaker. Roar in both ears. Hearing very little. What can you give me on closed head injuries and this kind of condition. Nerve conduction studied are at least consistent with previous exam. I don't think there was a basilar skull fx. according to CT. but had the Battle Sign on Left ear.
Thanks.
Reply ------------------------
There are a number of possible explanations for the hearing loss you describe.
In order to determine which is most likely, it would be necessary to know more specific details regarding your audiogram, particularly whether your hearing loss is neurosensory, conductive, or mixed. Also was a tympanogram done to determine the function of your eustachian tube? Your post suggests that you may have had some hearing loss preceding your current problems and the description of your current problems suggests that your hearing levels have fluctuated.
Head trauma can cause purely conductive hearing loss by dislocation of any one of the 3 small ossicles in the middle ear that transmit sound energy from the ear drum to the inner ear. Such ossicular problems can occur with or without a basilar skull fracture. An intact and normal appearing ear drum combined with a purely conductive hearing loss following closed head trauma would suggest this type of injury. A high resolution CT scan of the middle ear might be helpful, but the diagnosis would require an exploratory tympanotomy. This type of problem generally is amenable to surgical repair.
Basilar skull fractures can cause pure neurosensory, pure conductive, or mixed forms of hearing loss. They can also be associated with vertigo due to inner ear trauma or facial nerve paralysis. Basilar skull fractures can be difficult to visualize radiographically in some cases. Pure neurosensory losses will most likely be permanent in most cases as this suggests trauma to the 8th cranial nerve or the cochlea of the inner ear. Conductive losses may be amenable to surgical repair, but generally is delayed in basilar skull fractures to allow for sealing of any potential cerebrospinal fluid leakage.
Mixed forms of hearing loss following closed head injury, especially when associated with fluctuating hearing levels or episodic vertigo (particularly vertigo associated with exertion or straining) may be caused by leakage of fluid from the inner ear, a condition known as perilymphatic fistula. Perilymph leaks can occur from the oval window where the stapes bone is located, or the round window. In the majority of cases, perilyphatic leaks are felt to close spontaneously with bedrest. If symptoms persist for more than 2-3 weeks despite bedrest, surgical exploration and repair of any observed leakage is usually recommended. Although perilymphatic leakage can resolve either spontaneously or with the help of surgical repair, the neurosensory component of the hearing loss may be permanent. Resolution of perilymphatic leakage will generally result in stabilization of fluctuating hearing levels and improvement in vertigo.
The fact that nasal steroids and antihistamine-decongestant medication has been prescribed suggests that mucosal inflammation has been identified such as that which is present in eustachian tube dysfunction or nasal-sinus disease. The type of hearing loss associated with these conditions is usually conductive. The only correlation I can surmise between your head injury and an inflammatory process would be the possibility of the development of paranasal and/or sinus disease that has resulted from complications related to your "blowout" fracture.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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