Whiplash injury and neuro-otological sequelae: An evidence based systematic review. (June 2014)

• Record Type: Journal Article
• Authors: Samji, Alim; Thiagarajan, Venkataramana; Yeoh, Robin
• Is Part Of: Hearing, balance and communication. Volume 12:Number 2(2014:Jun.)
• Page Start: 66
• Page End: 77
• Publication Date: 2014-06
• Subjects: Audiology -- Periodicals; Hearing disorders -- Periodicals; 612.85
• DOI: 10.3109/21695717.2014.910896
• Languages: English
• ISSNs: 2169-5717

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective:</italic> Epidemiological data showing an association between whiplash and neuro-otological symptoms have existed for many years; however, despite growing evidence a causal relationship has not been forthcoming. This review aims to identify whether evidence exists to substantiate a pathophysiological link between whiplash and its presumed neuro-otological consequences. <italic>Study design:</italic> A literature search was performed in accordance with 'the literature search process: guidance for NHS researchers', using the search terms 'whiplash', 'vertigo', 'hearing loss', 'dizziness', 'tinnitus', 'hyperacusis'. This was augmented using citation linking. <italic>Results:</italic> No evidence was found that satisfactorily proved a pathophysiological link, but there was evidence to support several plausible theories. For hearing loss and tinnitus/hyperacusis these include auditory processing disorders (APD) secondary to cerebral hypoperfusion due to stimulation of cervical nociceptive afferents; and Eustachian tube dysfunction secondary to temporomandibular joint dysfunction. For vertigo/dizziness they include 'cervical dizziness' secondary to damage to vestibulocollic/cervicocollic reflexes, osteoarticular tendon sensors/cervical neuromuscular spindles with resulting proprioceptive dysfunction and discordance with visual input; central or peripheral vestibular pathology; and psychosocial factors. <italic>Conclusions:</italic> The results highlight the multifactorial, biopsychosocial nature of whiplash. Although the largest contributors to neuro-otological symptoms appear to be psychosocial, the results identify promising, if largely theoretical, pathophysiological mechanisms. Unfortunately, much of the work is underpowered and often lacks controls. It therefore creates a need for further research and forms a basis for that research.</p> </abstract>