Our Approach
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.
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Concussions
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.
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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.
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Diagnosis
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.
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Treatment
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.
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