Hearing Loss Following Whiplash
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
Published:
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
cause."
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.
