Contralateral deafness post head injury without temporal bone fractures

Abstract

We report an unusual case of contralateral deafness in a 31-year-old man after an uncomplicated blunt force head injury. The patient was presented with a left-sided head injury and complained of profound deafness in his right ear, dysequilibrium, and vertigo. Pure tone audiogram revealed total sensorineural deafness in the right ear. A high-definition computed tomography scan demonstrated no radiological evidence of bony injuries or a fistula. His dysequilibrium had improved 2 months later, but his vertigo and hearing loss persisted. We will discuss several possible mechanisms of injury that may result in deafness after head injury without bony fractures. The literature has been reviewed. Although deafness is not an uncommon complication of head injuries, its presentation in the contralateral ear in the absence of temporal bone fractures following head injury has not been reported before in the medical literature.

1 Case report

A 31-year-old man was referred to the Department of Otorhinolaryngology complaining of deafness in his right ear and sensation of dysequilibrium and vertigo. The evening before, he had been assaulted and punched repeatedly on the left side of his head. He denied any injuries to the right side of his head. The patient had no previous problems with his hearing or ears, and hence, we had no reasons to believe that he did not have normal hearing before the incident although we have no prior audiological records.

Clinical examination showed a normal intact right tympanic membrane. He had no obvious rhinorrhea or otorrhea. He had a false-negative Rinne test in his right ear, whereas the fistula test was negative. Neurological examination was unremarkable apart from a first-degree nystagmus toward the left. Pure tone audiogram demonstrated total sensorineural deafness in his right ear and normal hearing in his left ear (see Fig. 1 ). Tympanogram of the right ear showed a type B pattern (see Fig. 2 ). A high-definition computed tomography (CT) scan of his internal auditory meatus and brain confirmed fluid in his right middle ear (see Figs. 3 and 4 ). Nevertheless, there was no radiological evidence of any skull base fractures or any obvious fistulas. Both ossicular chains were intact.