One Head Trauma, Three ENT Manifestations

Abstract

Introduction: It is well known that head trauma (HT) can cause hypoacusis; as well as benign positional paroxysmal vertigo (BPPV) and anosmia, which are frequently referred as sequelae of HY. However, the post-HT triad of BPPV, hypoacusis and anosmia is extremely rare to occur in the same patient, with only two cases reported in the literature. With this case report we wish to describe a clinical case of HT that caused hypoacusis, BPPV and anosmia as sequelae, and to review the importance of ENT evaluation in some cases of HT, even in the absence of cranial fractures. Results: We describe the case of a 71-year-old patient referred to ENT consultation with complaints olfactory changes, vertigo and worsening of left hearing loss with tinnitus after HT. Physical examination revealed the presence of anosmia (UPSIT®: 7 correct answers), left posterior semi-circular canal BPPV and left ear conduction hearing loss (Rinne negative on the left and Weber lateralized to the left). Audiometrically, the patient had moderate grade I mixed deafness of the left ear, with good discrimination and worsening compared to previous exams. CE-CT performed within hours after trauma showed left frontobasal and temporal contusion with scattered subarachnoid hemorrhage and subdural hematoma. A cycle of systemic corticosteroid therapy was attempted without favourable evolution of the anosmia. Conclusion: Even without traces of cranial fracture, post-HT ENT involvement can be complex. After HT the membranous labyrinth may be affected by concussion/ stretching of the Corti organ. On the other hand, after intracranial hemorrhage there may be decreased inner ear pressure. HT can also shift otoconia to different semicircular canals, which is the proposed mechanism for post-traumatic BPPV. Finally, frontal and/or temporal concussions, as well as disruption of olfactory fillets, are the most common causes of post-HT olfactory changes, which are often irreversible. In conclusion, otolaryngologists should be aware of the various post-traumatic ENT manifestations, as early identification and treatment of post-HT sequelae can improve the prognosis.