Dr Peter Savundra, Consultant Audiovestibular Physician, provided insight on managing complications caused by damage to the audiovestibular systems after brain injury at our annual brain injury lecture on the 25th May 2017.
The lecture which lasted an hour started by addressing A&E care and emergency medicine which has improved dramatically in recent years. In the 1930s and 40s, brain injuries were usually fatal. In 2017, many patients survive and at first glance appear entirely unharmed. Modern medicine must focus on the ‘hidden’ damage arising from brain injury.
Patients with brain injuries can have ongoing symptoms of pain, vertigo, fatigue, tinnitus and other symptoms as a result of concussion of the auditory system. This can have a significant impact on their quality of life.
The lecture continued with focus on the areas below.
The auditory and vestibular systems
The ears have two main functions: they allow a person to hear and assist with balance.
The auditory system is responsible for the sense of hearing and consists of the outer ear, middle ear, cochlea (and its nerves and nuclei), limbic system, auditory and attention pathways.
The vestibular system includes the inner ear and brain. It integrates the vestibular, visual, proprioceptive and auditory inputs as well as gravity receptors and feedback circuits. These are then processed by the body to assist balance and enable eye movements, muscle activity and autonomic (unconscious) responses.
The brain is involved in a major network. A person can suffer from peripheral damage and damage to the brain itself, resulting in a range of symptoms. Additionally, brain injuries can cause symptoms with no peripheral damage: it is possible for a person to experience ear symptoms without damaging the ears themselves. Conversely, when brain processing is affected, pre-existing peripheral damage can become apparent. There is often no correlation between the amount of damage caused and the severity of the symptoms.
Dr Savundra gave many examples of damage caused by brain injury, including:
- Central auditory processing – this is the capacity of the brain to predict and support the auditory input through speech signals. Brain damage can mean that these two systems no longer work in tandem
- The brain’s default network (which is active when the individual is thinking about others or themselves, remembering the past or planning for the future) is also involved in vestibular processing and can be affected by brain injury
- Side effects – The delicacy of the ear means that any damage or impact to the skull can cause noticeable side effects, for example vertigo is perceived by the brain when there is a mismatch of visual, vestibular and proprioceptive cues
The brain is made up of huge numbers of neural connections which are all interlinked. Treating discreet injuries frees up the connectomes and allows the brain to focus on other cognitive processes.
Dr Savundra emphasised the importance of exercise and balanced diet in improving a brain injured person’s prognosis. It is also important to take a holistic approach by listening to the patient and considering their medical history in detail.
Obtaining the right experts
Dr Savundra highlighted the need to find an expert in the right branch of neuro-otology as it is a large specialism with many sub-specialities. This can help to pinpoint the cause of pain and identify other symptoms. Vestibular symptoms are often caused by brain damage which may not necessarily show up on scans. It is, therefore, important for a person to see the right specialist who is up to date with current medical progress.
The key message was that a team approach is essential in order to identify and treat people that are suffering such injuries.
Over many years, Thomson Snell & Passmore has worked with leaders in the field of rehabilitation care. We help them to find the right experts and specialists to identify the root of their difficulties and treat ongoing symptoms. This is one of the key reasons as to why we host this annual lecture for those who help people affected by brain injury, be it the person with an injury or their family.
The importance of compensation
Thomson Snell & Passmore provides peace of mind to clients and their families. We do this by focusing on getting the best possible compensation claim for a client to give them the specialist care they need. With compensation, we can introduce a care plan that aims to put our clients in the position they would have been if the accident had not happened. We can put in place a treating team and care managers to assist the rehabilitation process. For us it is about quality of life.
We have been recognised by The Modern Law Awards for Personal Injury Team of the Year, and maintain number one rankings with prestigious independent guides to the legal profession, “Chambers and Partners” and “The Legal 500”. Our personal injury team has specialist experience in the area of brain injuries and an understanding of the ongoing implications for people’s lives.