TBI DIZZINESS

As previously reported in Medical Litigation News, damage to the balancing mechanism can be demonstrated objectively after whiplash injury of the neck (Volume 2, Issue 2) and Mild Traumatic Brain Injury (Volume 2, Issue 9).

Perilymph Fistula is a controversial explanation for some occurrences of prolonged postural dizziness, with or without hearing loss[1], following both TBI[2] and whiplash[3]. Women are more susceptible than men[3].

PRACTICE POINT

Postural dizziness and deafness after Traumatic Brain Injury or Whiplash injury of the neck may be caused by Perilymph Fistula

The diagnostic controversy[4] arises because there is no definitive test short of exploratory surgery of the inner ear, and the operation itself can and occasionally does cause a Fistula - leakage of perilymph fluid from the system of semicircular canals which houses the balancing mechanism.

PRACTICE POINT

Diagnosis, even after exploratory surgery, remains controversial

Even if the battery of preoperative tests predicts a probability that Perilymph Fistula is the cause of such postural dizziness, the wide range of possible outcomes must be considered as a basis for informed consent. Patching the leak results in complete and dramatic abolition of the symptoms in a minority, some patients derive no benefit from the operation, and the majority improve partially[1].

PRACTICE POINT

Outcome of corrective surgery is variable and unpredictable

Worsening after surgery is not a priori evidence of substandard operative technique.