Post-Concussion Syndrome and Perilymph Fistula
 

Hi,

I am now almost a year post-concussion and I am still experiencing mild symptoms but now I finally have some closure as to what is causing it. I was symptom free (tinnitus, hyperacusis, mood disorders, memory and concentration problems) at 6 months and the tinnitus and hyperacusis returned at an intensity far more severe than I ever experienced following the hit to my head accompanied by headaches and dizziness. I returned to my hometown to see my Doc and I passed all of the balance, eye-movement, and cognitive tests. Two ImPACT tests indicated that I was functioning in the 90th percentile of speed and memory, which is better than baseline scores. I am still able to perform intense economic calculations as a college student and even made it on the Dean's List last semester. Turns out that most of the post-concussive symptoms that I experienced were caused by a Perilymph Fistula, a tear in the membranes in the middle and inner ear, a physical injury, not a neurological dysfunction, that was initially caused by the concussive impact and then re aggravated by the loud music at the concert. I want to post some tips for those that may be suffering from these similar symptoms.

1. See an Otolaryngologist (Ear, Nose, and Throat). They can confirm if this is the cause of your post-concussive symptoms (vertigo, dizziness, headache, tinnitus, hyperacusis, fatigue, mood problems).

2. Eat right and take vitamins. Blueberries, strawberries, spinach, onions. Anything that helps to reduce inflammation. Also stay hydrated and avoid smoking. Smoking restricts the blood vessels, there is only one small vessel that provides blood and essential nutrients to the ear.

3. Avoid excessive noise, but do not plug your ears for everyday noises. The torn membranes need to be gradually worn in again by normal sounds. If you are at a concert, wear ear plugs. I suggest silicon gel ear plugs that can conform to the shape of your ear.

4. Changes in air pressure will make your symptoms worse. Prepare for the worst when it is a cloudy, rainy day. Do not fly in an airplane or go into the mountains.

5. Exercise. Light jogging and light weights are key to making my symptoms as mild as possible, but do not over-do it. No bench presses or squats. Don't run in a marathon and avoid contact sports until you are symptom free.
If this makes your symptoms worse, then stop.


Post-concussive symptoms are strange and frightening, but they most likely have a physical cause and is not an indication of brain damage. If your ears are fine, look for problems in the neck as well. The vibrations of such an impact that causes concussions are not absorbed exclusively by the skull. All of the systems surrounding it are subject to damages as well. Good luck!

Thanks for your tips-they are very helpful. I'm glad to see that you are doing well as you recover, especially with school.

I'm curious, was there a test your ENT did to confirm Perilymph Fistula? I'm going to UCSF's neuro-otologist (but not to September) to pinpoint my central and peripheral vestibular issues (some symptoms are very similar to yours).

I have a short family vacation that requires a 6 hour plane ride, so I am a bit nervous!

I did not need a test. My neuropsychologist and my physiatrist consulted with an ENT after my cognitive tests came back so positively and it is "highly likely" in their words that this is fistula that was re aggravated from my initial injury by the loud music (I am also a professional musician, so I am constantly encountering loud sounds). There are several tests that can be performed but are rather invasive and should not be performed unless the symptoms fail to improve because they can actually worsen tinnitus and dizziness for a time after the tests.

As for the plane ride, I would strongly suggest avoiding it. I flew from London to Pittsburgh 6 weeks after my ear injury and experienced worsening symptoms in the weeks following the trip. This is called barotrauma from the fluctuating pressure in the cabin. Changes in elevation and barometric pressure from the weather also affect my tinnitus and hyperacusis. I was able to fly prior to my 2nd injury, which was 5 months post concussion without any problems at all though. At the moment, until this injury heals, I am avoiding all forms of long travel and doing my rehab exercises. Do what you think is best.