Peripheral and Central Audiological Sequelae of Closed Head Injury: Function, Activity, Participation and Quality of Life

Abstract

The aim of the present study was to analyse long-term effects of closed head injury (CHI) on peripheral auditory function, presence of central auditory processing disorders (APD), impairment, communicative function, activity and quality of life (QoL), including an evaluation of a new methodology (Acoustic Environmental Test, AET). From a total of about 600 patients with CHI of sufficient impact to cause fracture of the skull base and/or brain contusion, 66 patients had, in close proximity to the trauma, been evaluated with pure tone audiometry and 45 of these were in the present study evaluated 2–13 years after trauma. The design was focused on type of lesion and type of consequence. The initial classification of head injury was evaluated with computed tomography and the Swedish Reaction Level Scale (RLS). A standardized anamnesis was obtained from each subject. In all subjects, pure tone audiometry and distorted speech audiometry (interrupted speech, IS) were performed, and questionnaires regarding hearing, the Gothenburg profile, and regarding quality of life, EATS (Efficiency of Assistive Technology and Services) were administered. Eighteen subjects completed the AET in a specially designed acoustic environment room. There was also a focus on the ICF (international classification of functioning, disability and health) concept. Twenty-five cases had skull fracture only, nine cases fracture and brain contusion and 11 cases brain contusion only. There was a high prevalence of reported tinnitus (56%), vertigo (38%) and memory deficiencies (40%). Pure tone audiometry was significantly poorer in the trauma group than in a matched control group, and 32 subjects (71%) showed progress of ⩾15 dB at one or more frequencies. Twenty-eight subjects demonstrated pathological results on the IS. In the AET, four subjects had no problems with sound localization with a fixed sound source, but obvious problems in localizing a moving sound source. In general there was good agreement between self-assessments and test results, but there were also individual cases with considerable discrepancies. Peripheral hearing impairments, APD, cognitive deficiencies, tinnitus and vertigo are common long-term sequelae of CHI. APD and vertigo were more common among women. The new test method AET was able to demonstrate signs of binaural hearing deficiencies in a considerable number of cases with normal pure tone averages. Although there was generally good agreement between self-assessments and test results, some cases of pronounced differences were present. In particular, the attempt to apply ICF to these subjects highlights the importance of the individual's own evaluation of her or his situation.

• hearing
• audiometry
• closed head injury
• Gothenburg Profile
• EATS (Efficiency of Assistive Technology and Services)
• interrupted speech
• Acoustic Environmental Test
• ICF