Cochleovestibular disorders in neck injuries: causes, symptoms, diagnosis, treatment

In the pathogenesis of a number of labyrinthopathies, along with osteochondrosis, snundilosis of the cervical spine, pathological tortuosity and other abnormalities of the vertebral artery, a definite role is played by acute and chronic neck injuries, which cause damage to blood vessels and nerves, which play an important role in the functions of the inner ear (vertebral artery, cervical sympathetic plexus, etc.). This provision was formulated and developed by A. De Klein (1927), who described the phenomenon of cervical dizziness, and W. Berci-Roshen (1949), who described some manifestations of vestibular dysfunction in neck injuries.

Pathogenesis and clinical picture of cochleovestibular disorders in neck injuries. Injuries to the neck are divided into chronic and acute.

Chronic trauma occurs with frequent mechanical effects on the anatomical formation of the neck, not causing obvious damage to the ligament, cartilage and bone apparatus of the cervical spine. These influences are caused either by forced production positions of the body and head, or by the employment of appropriate sports (assembly work in narrow and low spaces, boxing, wrestling, etc.). The developing symptom complex, in addition to chronic radiculoalgia, manifests itself in the signs of the Martland syndrome - posttraumatic encephalopathy, which occurs in professional boxers as a result of head and neck injuries caused by it, manifested by memory loss, slowness of thinking and multiple brain sclerosis leading to Parkinsonism or even to symptoms, similar signs of Alzheimer's disease) in combination with signs of vertebral-basilar vascular insufficiency. Signs of vertebrogenic labyrinthine dysfunctions and Martland's syndrome are observed with chronic effects on the spine of general vibration with pronounced degrees of vibration sickness.

Such patients complain of headaches, insomnia, irritability, frequent attacks of dizziness. They show signs of vegetative-vascular dystonia, increased sensitivity to accelerations with simultaneous hyporeactivity to provocative tests, and hearing loss of various degrees.

Acute trauma to the neck occurs with sudden violent flexion, extension and twisting of the neck, with sharp lateral head dislocations caused by shock, falling from height to feet or head. A whiplash injury of the neck occurs with a sharp forcible flexion or extension of the head, while the muscles and ligaments of the neck are damaged, the upper parts of the spinal cord stretch, and sometimes the bruise of the latter on the cervical vertebra II. Typical localization of the trauma of the cervical spine are V-VIII vertebrae. In this area, spinal dislocations are most common. Most often, the trauma of the cervical spine occurs when the neck is stretched, for example, when hanging during execution or suicide.

With neck injuries, the spinal cord is damaged as a result of the direct action of vertebral bodies or bone fragments on it. In this case, blood circulation and lymph drainage are disturbed, there are intracerebral and shell hemorrhages, swelling and swelling of the brain substance. Extensive hematomas at the base of the skull in the region of the large occipital foramen can be manifested in the elements of the Laruel syndrome - increased intraocular pressure, paroxysmal pain in the occiput, vomiting of the central origin, spasm of the cervical musculature, torticollis, tachypnea, convulsive swallowing, masculine face, congestive optic nerve disc, negative test (symptom) of Quakenstedt (the test reveals a sign of impaired circulation of the cerebrospinal fluid - in healthy people, compression of the jugular vein increases intracranial pressure, which can be seen from the increased frequency of droplet discharge during lumbar puncture, when the central canal is compressed in the region of the large occipital orifice, there is no swelling of the cerebrospinal fluid), or the syndrome of the large occipital foramen. Trauma to the neck can cause repercussion damage to various parts of the brainstem (degeneration of neurons of the lateral vestibular nucleus, reticular formation and even red nucleus).

Injury of the vertebral artery leads to the development in them of small aneurysms or to the formation of posttraumatic atherosclerotic plaques that cause arterial stenosis.

Symptoms of a whiplash injury of the neck consists of three periods: acute, subacute and the period of residual phenomena.

The acute period is characterized by a number of immediately appearing after trauma symptoms such as the triad of Charcot (intense tremor, chanted speech, nystagmus - the main symptoms of multiple sclerosis), as well as headache, tenderness in the neck with palpation and movements, dizziness, spontaneous nystagmus, hyperacostic, ear noise , various vegetative disorders.

Diagnosis of labyrinthine disorders in this period is limited to the study of hearing by live speech, by tuning fork, if possible by tonal threshold audiometry and by the presence of spontaneous pathological vestibular reactions. All studies are conducted under strict bed rest.

For the subacute period, delayed symptoms that appear after 2 to 3 weeks after trauma are characteristic. There are attacks of sharp pains in the neck, both spontaneous and arising during movements in it, a protective (not meningeal) rigidity of the occipital muscles, caused by pronounced radicular syndrome. Against the backdrop of non-systemic dizziness with passive head turns (they should be done very slowly, with great care, at a limited angle, as they cause sharp radicular pains), systemic dizziness and spontaneous horizontal rotator nystagmus occur. These signs are a harbinger of serious pathological changes in the neuro-vascular apparatus of the neck, causing the development of the so-called ataxic syndrome. The latter is characterized by impaired fine coordination of the upper extremities (their ataxia), static and dynamic balance (staggering and falling in the Romberg pose, gait disturbance), cervical positional nystagmus and dizziness, strong permanent root pains in the neck, irradiating to the humeropathy areas and upper limbs.

The resulting pathological changes in the cervical sympathetic plexus due to primary trauma and secondary phenomena (hemorrhage, edema, compression) are the cause of pronounced vascular dysfunctions both in the ear maze, and in the meninges and remote regions of the brain, migraine attacks and often "flickering "Focal symptoms. The most characteristic signs of vasomotor disorders in the inner ear are permanent ear noise, dizziness, cervical positional nystagmus. In general, the clinical manifestations in this period are characterized by signs close to the syndromes of Barre-Liège and Berci-Roshen. Subacute period can last from several weeks to 3 months. By the end of the period, the condition of the victim is gradually normalized, but his capacity for work, depending on the severity of the injury, is either long-term or limited.

In the period of the residual phenomena of the victim, tinnitus continues to be disturbed, in some cases, progressive hearing loss by the type of disturbance of sound perception, dizziness attacks accompanied by nausea and weakness, persistent, painful attacks in the neck, especially at night and with sharp turns of the head. On the tone audiogram, a descending type of bone and air conduction curves of a symmetric or asymmetrical character is revealed, while a mixed type of interlabyrinth asymmetry is revealed in provocative samples (with bithermal and threshold rotational tests). The third period can last from several months to several years, and in some cases, residual phenomena in the form of cervical radicalgia, migraine, stiffness in the cervical spine, hearing loss, etc. Can last a lifetime.

Treatment of cochleovestibular disorders with neck injuries. Neck injuries associated with damage to the spinal cord, nerve trunks and plexuses, vessels, ligamentous-joint and bone apparatus, involve the involvement in the treatment of such patients of many specialists (neurosurgeon, neurologist, traumatologist, orthopedist, ENT specialist, otoneurologist, surdologist, ). With violations of auditory and vestibular functions, antianrhytic and sedative treatment methods are used.

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