Here at Ear Institute of Texas (EIT), we objectively evaluate each patient as an individual to determine the extent and specific nature of their concussion. The physician at EIT has specialized fellowship training in both neurotology and otology, and utilizes the latest medical advances to objectively evaluate each patient individually, addressing their concussion through a multi-dimensional approach to both diagnostic testing and treatment. EIT has adopted the most widely used and accepted methods of evaluation and treatment, combining them with technological advances to establish a concussion protocol that allows for an approach that focuses on the causes of the symptoms rather than the symptoms themselves. As a result, patients can have a faster and safer return to activities of daily living.
A concussion is defined as an immediate acceleration, deceleration, or stopping event causing temporary or permanent damage to the structures of the head. The symptoms of a concussion can indicate both the mechanism of the injury and the specific structures within the head that may be damaged. Symptoms can include: disorientation, dizziness, nausea, “blurred” vision, loss of coordination and concentration, amnesia, and loss of consciousness.
When people think of a concussion, their first instinct is to think of brain trauma, which is not always the case. There are other structures within the head that are considerably more sensitive and more easily damaged than the brain, for example the vestibular system.
The brain has a considerable amount of protection from the structures around it, and is generally associated with immediate and severe symptoms. It does takes a great amount of force to damage the brain, and these injuries are usually seen in motor vehicle accidents or other high speed or high velocity events. They do occur in sports, but their frequency seems to be lower than initially thought. The vestibular system (inner ear) on the other hand is rather easy to disrupt in comparison to the brain, and current research is providing some evidence that a large portion of concussional injuries are actually damage to the inner ear or vestibular system, rather than the brain. A majority of common symptoms: headache, dizziness, nausea, blurred vision, and coordination and concentration problems that are associated with a concussion can be directly and in some cases solely attributed to the vestibular system. Only in recent years, with advancements in medical technology, have we been able to accurately and objectively evaluate the vestibular system, which is why it is considered one of the most misunderstood organs of the body.
Due to the potential involvement of various systems, it is quickly becoming the standard of care to treat a concussion from more than one perspective. Concussions should be evaluated with the understanding that there are different types of concussions. No two concussions are the same and they need to be evaluated on individual basis.
The different types of concussions:
1. Vestibular concussions (inner ear)
2. Cerebral concussions (brain)
1. & 2. A combination of both (inner ear and brain)
Both vestibular and cerebral concussions have similar symptoms, making it difficult to distinguish. Therefore, the key to treating a patient is distinguishing between the different types of concussions and accurately diagnosing each injury. Advances in medical technology and diagnostics allow specially trained physicians the ability to view a concussion through its many causes and subsequent symptoms. Keeping in mind that the treatment for each is significantly different, and treating one concussion like the other may slow or prevent a full and safe recovery.
Sports Related Injuries
Sports related concussions generally occur in collision/contact sports such as football, ice/field hockey, basketball, and soccer. However, their impact is also seen in sports ranging from baseball to gymnastics and all recreational sports. When the head is put through a forceful and immediate stopping or starting, structures within the head can be damaged.
The diagnosis of a concussion is made by a combination of historical information, physical examination findings, and diagnostic testing that includes: postural sway analysis, vestibular ocular reflex testing, audio-vestibular testing, and occasionally imaging techniques to include a CT or MRI scan. Both the central nervous system and balance system are evaluated using a combination of testing techniques. This testing protocol will identify any damage or weaknesses in the vestibular system, visual system, proprioceptive (sensation) system, and/or coordination and reflexes of the brain. There is a characteristic pattern for the evaluation of concussion: central nervous system concussions will present both objectively and subjectively different than a vestibular concussion. Vestibular concussions will have a very predictable abnormality, showing a specific correlation within a number of the diagnostic tests, allowing for an accurate identification of each injury.
The treatment for a concussion will vary greatly for each individual, as each injury is significantly different and can fluctuate in both the severity and duration of symptoms. As a result, our physician and team of professionals will individually evaluate each injury, focusing treatment protocols on the causes of the symptoms rather than the symptoms themselves. Medical treatment will include the stabilization of the injury, in some cases with medication, rest, or specialized vestibular therapy.
The aim of treatment is to prevent the symptoms of a concussion from worsening (as they initially do over the first three day period), and then preventing them from having a negative impact on life. If a concussion is seen within the acute period (generally the first 12-72 hours), a majority of the lingering symptoms can be prevented from occurring. After this acute period, if no treatment is given, the central nervous system (CNS) and other systems begin to compensate for the injury, creating periods of “good days” and “bad days”. This cycle can continue for days, months, or years. A concussion having long lasting effects is commonly referred to as the post-concussion syndrome and can be treated with a similar methodology: stabilization of the vestibular system and retraining of all the sensory input systems. The process of retraining a stable vestibular system is to allow the sensory systems of the body to more effectively coordinate their individual activities with one another and the external environment. As a result, treatment protocols are very individualized and are tailored for each patient based on their specific needs; no two treatments will be the same, nor will two patients respond in the same way.