What type of head trauma can lead to inner ear problems?

Trauma to the head can lead to inner ear problems through ‘direct’ or ‘indirect’ mechanisms. Direct head trauma involves direct physical injury to the head that most commonly occurs after falls, motor vehicle collisions or assaults. Indirect head trauma commonly occurs through blows to the body where rapid acceleration-deceleration forces (e.g. motor vehicle collisions without direct head injury or tackle injuries in sport) cause the brain to ‘wobble’ in the skull increasing the risk of injury to the structures of the inner ear.

Head trauma can be classified by its severity as either mild (often referred to as ‘concussion’), moderate or severe. The injury severity due to head trauma should be made by a medical professional with specialist experience. Inner ear problems can occur after all types of head trauma and will vary for all individuals.

The structures of the inner ear are located in the skull just behind both ears. Both inner ears communicate through complex pathways that go to numerous regions in the brain. Head trauma can therefore impact any part of this pathway and specialist assessment with physiotherapists who specialise in vestibular disorders (dizziness/balance problems) could prove very beneficial.

Dizziness after head trauma

Symptoms of dizziness are commonly reported after trauma to the head. In fact, dizziness is present in 23% to 81% of cases in the first few days after injury. The reasons for the wide range of reported dizziness symptoms includes the following:

• Depending on injury severity, dizziness may not be apparent in the initial days if people are not moving around as much
• Dizziness is a complex symptom and often is difficult to describe
• Some health professionals may not be aware of inner ear problems after head trauma and therefore may not ask specific questions about dizziness or balance issues
• Dizziness may be attributed to non-vestibular (non-inner ear) problems

Dizziness after head trauma can feel different for different people. Some common descriptions of dizziness include the following: vertigo (spinning), light-headedness, swimmy, floaty, unsteadiness, imbalance or unclear vision. Symptoms of dizziness can occur in different situations: changing position (e.g. turning in bed), busy environments (e.g. local grocery store), moving your head (e.g. walking and looking around).

Do not worry if your description of dizziness is not here – everyone has their own way of describing how they feel – and this is normal

What other symptoms are common with dizziness after head trauma?

It can be common to experience other symptoms with dizziness after head trauma:

• Somatic symptoms (hearing problems, headaches, sensitivity to light/sound, neck pain)
• Emotional symptoms (anxiety, low mood, irritability)
• Cognitive symptoms (reduced attention and memory, ‘fogginess’)
• Sleep symptoms (difficulty getting to sleep, difficulty staying asleep)

All these symptoms are common after head trauma and are amenable to treatments in collaboration with the appropriate health professional – it is important to speak with your GP if you have any concerns about any symptoms mentioned above

Physiotherapy for inner ear problems

It is very common for individuals with any type of inner ear problem to restrict their level of activity and stop participating in their normal daily activities e.g. cleaning the house, shopping, walking or working. Restricting these normal activities because of inner ear problems can actually slow down the recovery from an inner ear injury.

Physiotherapists specialising in vestibular disorders can help with recovery from dizziness after head trauma. Vestibular physiotherapists can perform a thorough assessment to determine the underlying cause of your inner ear problems and then develop a specific and individualised treatment plan. Treatment will include education and specific exercises or techniques to help reduce dizziness, improve balance and general fitness levels.

Recovery takes time, sometimes months, so it is very important that you get back to your prior activities as soon as possible. Successful recovery takes commitment and patience. Research shows that avoiding movements and activities that make you dizzy may complicate your recovery – so following the specific rehabilitation programme from your vestibular physiotherapist gives you the chance to obtain the best possible outcome.