LM401 - Concussion Complexities: The Importance of Audiology in Traumatic Brain Injury Evaluation and Management

Abstract:
Concussion and traumatic brain injury can occur at any age. Multiple medical providers are involved when an individual suffers from a concussion or traumatic brain injury (TBI). Audiologists are important parts of this multidisciplinary team as symptoms can involve dizziness, imbalance, tinnitus, hearing loss, and auditory processing difficulties. Managing these individuals requires multidisciplinary teamwork and most audiologists need to go outside their usual comfort zone to do so. This session will discuss the team approach to concussion care, why audiology is an integral part of concussion care, and how audiologists can help patients with a concussion or TBI.

Summary:
Individuals with traumatic brain injury (TBI) and concussion (mild TBI or mTBI) need a multidisciplinary approach for the assessment and management of symptoms and audiologists are considered important parts of the team. TBI and mTBI are caused by a jolt, bump, or blow to the head or body that results in back-and-forth brain movement within the skull. Chemical changes and brain cell changes or damage occur within the brain as a result (Centers for Disease Control and Prevention, 2019). Each individual will present with unique symptoms that may include headache, dizziness, imbalance, cognitive issues, mood changes, nausea, hearing difficulties in noise, hyperacusis, tinnitus, and many other symptoms. Symptoms may last for a few days or months post-head trauma. Existing guidelines usually include vestibular as a category of consideration, but often do not include auditory concerns (Theodoroff et al., 2022).

Baseline testing involving audiology usually includes balance assessment and occasionally hearing testing. After an individual suffers a TBI/mTBI, the audiological assessment may include pure tone audiometry, middle ear assessment with tympanometry and acoustic reflexes as tolerated, speech in noise testing, videonystagmography (VNG), postural stability, rotary chair, video head impulse test, and/or vestibular evoked myogenic potentials. Management of auditory symptoms may include hearing aids, tinnitus masking devices, tinnitus retraining therapy for tinnitus and/or hyperacusis, bone-anchored hearing aids, cochlear implants, and/or auditory processing training. Management of vestibular symptoms may include canalith repositioning and clinician and home-based vestibular rehabilitation (Bartholomew et al., 2020; Hac & Gold, 2022).

Many multidisciplinary concussion clinics may not include audiology. In this session, we will discuss the important role of audiologists in concussion from baseline testing through treatment. The presenters serve as key medical personnel on multidisciplinary teams for TBI/mTBI care for private practice and government contracting. Case studies will be used to improve understanding of these complicated cases.

References:
Bartholomew, R.A., Lubner, R.J., Knoll, R.M., Ghanad, I. Jung, D., Nadol, J.B., Alvarez, V.E., Remenschneider, A., & Kozin, E.D. (2020). Labryinthine concussion: Historic otopathologiy of a challenging diagnosis. Laryngoscope Investigative Otolaryngology, 5(2), 267-277. https://doi.org/10.1002/lio2.360

Center for Disease Control and Prevention. (2019). What is a concussion? https://www.cdc.gov/headsup/basics/concussion_whatis.html

Hac, N.E.F. & Gold, D.R. (2022). Neuro-visual and vestibular manifestations of concussion and mild TBI. Current Neurology and Neuroscience Reports, 22, 219–228. https://doi.org/10.1007/s11910-022-01184-9

Theodoroff, S. M., Papesh, M., Duffield, T., Novak, M., Gallun, F., King, L., Chesnutt, J., Rockwood, R., Palandri, M., & Hullar, T. (2022). Concussion management guidelines neglect auditory symptoms. Clinical Journal of Sport Medicine, 32(2), 82–85. https://doi.org/10.1097/JSM.0000000000000874