Hearing Loss Following Whiplash

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Thursday, June 04, 2009 

                        Hearing Loss following Whiplash

                        Written by Dan Murphy, D.C., D.A.B.C.O.
                        TAC, Research Review , Volume 31, Issue 5

                              TITLE: A Review of the Otological Aspects of
                              Whiplash Injury
                              CITATION:Journal of Forensic and Legal Medicine,
                              Volume 16, Issue2, February 2009, Pages 53-55
                              AUTHORS:R.M.D. Tranter and J.R. Graham
                              From abstract:v   Approximately 10% of patients
                              who have suffered with whiplash injury            
                                 will develop otological symptoms such as
                              tinnitus, deafness and vertigo.v   Some of these
                              are purely subjective symptoms; nevertheless, for
                              the                majority, there are specifi c
                              tests that can be               undertaken. These
                              tests can                quantify the extent and
                              severity of the symptoms, as well as provide
                              guidance                as to the correct
                              rehabilitation pathway.
                        KEY POINTS FROM DR. DAN MURPHY
                        1.    Approximately 10% of patients who have suffered
                        whiplash injury will develop otological symptoms such as
                        tinnitus, deafness and vertigo.
                        2.    "Significant [whiplash-related] injuries can occur
                        following even low speed car collisions."
                        3.    "Simulated accidents have shown that a 5-mile an
                        hour rear end car collision can result in a positive
                        acceleration of 8.2 G and 4.7 G of the head and chest,
                        respectively. These forces explain the damage that can
                        occur to an unsupported neck."
                        4.    "Balance and hearing problems occur in 5-50% of
                        whiplash injuries."
                        5.    15–20% of whiplash patients develop "persistent
                        complaints including headache, vertigo, instability,
                        nausea, tinnitus and hearing loss."
                        6.    "High frequency hearing loss is the most common
                        form of hearing loss associated with whiplash injury and
                        is easily demonstrated with a pure tone audiogram. This
                        type of hearing loss produces difficulties hearing the
                        high frequency consonant sounds and makes it difficult
                        for the patient to discriminate speech, especially in
                        the presence of background noise or when several people
                        are talking."
                        7.    These authors consider hearing loss for whiplash
                        injury to be a permanent injury.
                        8.    The majority of tinnitus related to whiplash is
                        purely subjective, with no objective measurement testing
                        available, and there is no effective medical treatment.
                        [See Comments Below]. Consequently, the prognosis for
                        the resolution of tinnitus is "very guarded."
                        9.    The sensation of balance relies on the input of
                        three systems:
                        a.      The inner ear vestibular apparatus, the
                        labyrinth and semi-circular canals;
                                                            b.    Proprioception
                        sensors [very important for chiropractors];c.    Vision.

                        10. Post-whiplash unsteadiness may be due to altered
                        posture to protect the injured neck.
                        11. Following whiplash, the most common type of vertigo
                        seen is benign paroxysmal positional     vertigo (BPPV),
                        "which is characterized by a short duration of vertigo,
                        associated with movement of the head."
                        12. "Following trauma, the crystals of calcium carbonate
                        in the utricle become displaced and lie within the
                        labyrinthine fluid and, in certain positions, will
                        stimulate the balance nerve endings in the semi-circular
                        canals, causing brief sensations of spinning." The
                        appropriate treatment is a "series of movements of the
                        head which move the loose particles of crystal into the
                        utricle, where they will not cause stimulation of the
                        sensitive nerve endings in the semi-circular canals."
                         13. Therefore, BPPV is usually curable, but other forms
                        of labyrinthine damage are not so easily managed and may
                        not be curable.
                        14. Legally, "the expert medical witness simply needs to
                        be satisfied that there is at least a 51% chance (the
                        balance of probability) that the claimant’s symptoms are
                        attributable to whiplash injury rather than any other
                        COMMENTS FROM DAN MURPHY
                        Although this article notes that there is no effective
                        medical treatment for tinnitus, below are three recent
                        interesting non-medical approaches:
                        1.    Burkhard Franz and Colin Anderson. The Potential
                        Role of Joint Injury and Eustachian Tube Dysfunction in
                        the Genesis of Secondary Meniere’s Disease.
                        International Tinnitus Journal; 2007, Vol. 13, No. 2,
                        pp. 132-137. (This article suggests that tinnitus can be
                        treated by managing dysfunctions of the upper cervical
                        spine joints or TMJ.)
                        2.    Tullberg M, Ernberg M. Long-term effect on
                        tinnitus by treatment of temporomandibular disorders: a
                        two-year follow-up by questionnaire. Acta Odontologica
                        Scandinavica; 2006 Apr;64(2):89-96. (The results of this
                        study showed that TMD symptoms and signs are frequent in
                        patients with tinnitus and that TMD treatment has a good
                        effect on tinnitus in a long-term perspective.)
                        3.  Gungor A, Dogru S, Cincik H, Erkul E, Poyrazoglu E.
                        Effectiveness of transmeatal low      power laser
                        irradiation for chronic tinnitus. The Journal of
                        Laryngology & Otology; May 2008 (This was a prospective,
                        randomised, double-blind study using a 5 mW laser with a
                        wavelength of 650 nm, or placebo laser, applied
                        transmeatally for 15 minutes, once daily, for a week.
                        Loudness improved 49%; duration of annoyance improved
                        58%; degree of annoyance improved 56%. The authors
                        concluded: "transmeatal, low power (5 mW) laser
                        irradiation was found to be useful for the treatment of
                        chronic tinnitus."
                        Dr. Dan Murphy graduated magna cum laude from Western
                        States Chiropractic College in 1978. He received
                        Diplomat status in Chiropractic Orthopedics in 1986.
                        Since 1982, Dr. Murphy has served part-time as
                        undergraduate faculty at Life Chiropractic College West,
                        currently teaching classes to seniors in the management
                        of spinal disorders. He has taught more than 2000
                        postgraduate continuing education seminars. Dr. Murphy
                        is a contributing author to both editions of the book
                        Motor Vehicle Collision Injuries and to the book
                        Pediatric Chiropractic. Hundreds of detailed Article
                        Reviews, pertinent to chiropractors and their patients,
                        are available at Dr. Murphy’s web page,
                        www.danmurphydc.com TAC.