The Medical Consumer's Advocate

Severe barotrauma (tire exploding) followed by dizziness and headache

Q: My brother suffered a concussion and acoustical trauma to his right ear from a tire exploding approximately two feet from his ear. This occurred (several months ago) and he is still continuing to experience dizziness and a severe headache without relief. He has seen an ENT physician and has been told there is nothing to be done, that it requires only time to heal, which could take up to five years. He is also having problems with his short-term memory. His MRI was normal. The physicians who have been treating him have never treated this type of injury before. Is there anything that can be done? Is it possible that one of the bones of the inner ear is fractured from the percussion that perforated his ear drum? We are desperately seeking any information we can to help alleviate his problem.

 

A: Your brother sustained barotrauma ("pressure trauma") to his right ear. The force of the explosion was severe enough to rupture his ear drum and give him a concussion. A concussion, by the way, is just a case of "rattled brain." The brain is a very soft organ, not too dissimilar to a bowl of jello, but a hell of a lot more complicated. Shake a bowl of jello, and all you get is jello; shake a brain, and severe injury can result due to damage to the millions of delicately interconnected nerve fibers (neurons.) In your brother’s case, this resulted in short term memory problems. His headaches may also be a consequence of this "shaking injury."

Barotrauma to the ear can result in many problems, including hearing loss and dizziness. The injury may be limited to the ruptured ear drum, but it is certainly possible that the tiny middle ear bones (that transmit vibration from the ear drum to the inner ear) could have been injured. The inner ear was certainly injured to some degree, since he continues to be dizzy. (The dizziness might also be related to his concussion, but I would bet that he had an inner ear injury.) There is such a thing as an "inner ear concussion." Also, fracture of the bone that encases the inner ear is also possible, but this is a pretty dense bit of bone.

His MRI is normal because the injury occurred at a cellular level. In other words, individual cells were damaged by the blast. MRI is good at detecting small problems, but it isn’t that good!

Can anything be done to help your brother? With regard to his headaches and short term memory loss, consultation with a neurologist would be an excellent idea. At the very least, a neurologist could find an appropriate medication to relieve your brother’s headaches.

With regard to hearing loss, much depends upon the nature of his hearing loss. Damage to the ear drum and middle ear bones can be corrected with an operation, if necessary. Damage to the inner ear cannot be fixed with an operation; if your brother has this type of hearing loss ("sensorineural hearing loss"), he may benefit from a hearing aid.

Finally, with regard to the dizziness, it is true that most of these problems will get better with time. That doesn’t help your brother, of course. As always, correct treatment can occur only after correct diagnosis. How much effort did the ENT spend investigating your brother’s dizziness? I hate questioning other doctors based upon the information people provide me in a brief letter, but on the other hand I am suspicious whenever I hear, "...there is nothing to be done." At the very least, your brother may benefit from a form of therapy called "vestibular rehabilitation."

"Vestibular" refers to the balance system located in the inner ear. "Vestibular rehabilitation" is a program of exercises administered by a therapist who has studied this form of therapy. Physical therapists and occupational therapists are often appropriately qualified.

Your brother should ask his ENT about vestibular rehabilitation. If he continues to get the "sorry, you’ll just have to live with it" answer, he needs to find another ENT. Another option would be to find an otologist. An otologist is an ENT who has had additional training in the medical and surgical treatment of ear problems.

 

Please also read this related letter.

 

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