Working Diagnosis:
Labyrinthine concussion

Treatment:
Rest and return to play protocol once symptoms resolved.

Outcome:
The patient returned to play after following the appropriate steps with the established return to play (RTP) protocol. His vertigo symptoms resolved after 2-3 days. He remained asymptomatic during the RTP and progressed well returning to game play after 1 week. He has remained asymptomatic.

Author's Comments:
Labyrinthine concussion is defined as inner ear symptoms after trauma with no well-defined skull fracture or injury. This condition happens when the puck hits the mastoid and causes vibration forces from the lateral impact on the temporal bone and hemorrhage into vestibule and semicircular canals. Symptoms include vertigo, tinnitus and hearing loss and can last days to weeks. Differentiation from other types of concussion is important and involves SCAT testing, neurological examination, and monitoring for the duration of symptoms. In cases where temporal bone injury is suspected and symptoms are worsening, a CT scan is recommended, most commonly revealing longitudinal temporal bone fractures. Ultimately, return-to-play occurs once the dizziness subsides and symptoms are not reproduced with activity or sport.

Editor's Comments:
In cases of concussion where there is concurrent facial trauma, it is easy to overlook the possibility of a concussion when there is a need to stop acute bleeding or to provide emergent care. Concussion testing and evaluation is important and should not be neglected, especially in the cases with concurrent head, facial, and otolaryngeal trauma. Recent research shows improved classification of the various types of concussions and treatment may be tailored to treat specific types of concussion.

References:
Chiaramonte, R., Bonfiglio, M., & D'Amore, A. (2013). Traumatic Labyrinthine Concussion in a Patient with Sensorineural Hearing Loss. The Neuroradiology Journal, 52-55.
Choi, M., Shin, S., & Yeon, J. (2013). Clinical Characteristics of Labyrinthine Concussion. Korean Journal of Audiology, 13-17.
Dinces, E., Kim, H., & Wiet, R. (2016). Evaluating Blunt Temporal Bone Trauma. Retrieved from Ento Key: https://entokey.com/evaluating-blunt-temporal-bone-trauma/
Encyclopedia Britannica. (n.d.). Bony Labyrinth. Retrieved from Britannica: https://www.britannica.com/science/vestibulocochlear-nerve
Hsu, K., Wang, A., & Chen, S. (2008). Mastoid bone fracture presenting as unusual delayed onset facial nerve palsy. American Journal of Emergency Medicine, 386.
Patel, A., & Groppo, E. (2010). Managment of Temporal Bone Trauma. Craniomaxillofacial Trauma & Reconstruction, 105-113.
Villareal, I., Mendez, D., & Duque Silva, J. (2016). Contralateral Cochlear Labyrinthine Concussion without Temporal Bone Fracture: Unusual Posttraumatic Consequence. Case Reports in Otolaryngology.

Return To The Case Studies List.