Visual and inner ear issues
Dizziness is the second most commonly reported symptom of a concussion (after headaches). Dizziness can mean different things to different people, for example, lightheadedness, spinning, rocking, floating, wooziness, etc. Dizziness and imbalance often go hand-in-hand; the former being a perception and the latter being its effect.
Before we discuss dizziness, let’s review some very basic relevant anatomy and physiology.
The labyrinth is the organ of the inner ear. It is comprised of a:
i. Regulates the ability of your eyes to see a stable visual image while you are moving
ii. One of the main organs that regulate the ability to maintain appropriate balance and posture.
b. Cochlea: the main organ responsible for receiving sound.
The specific reason for a particular case of dizziness/poor balance after a concussion can vary. In general, however, it is due to some change in the way the vestibule functions, the way signals are transmitted from the vestibule to the brain, the way the brain processes those signals and/or the way the brain utilizes this information to regulate your automatic reflexes – reflexes that most of us take for granted as we are generally not consciously aware of them.
Examples of some of the more common balance complaints include unsteadiness on one’s feet, clumsiness and/or falling. It would be helpful if patients note all those factors that seem to make dizziness and/or instability better or worse including its relation to certain activities, positions and movements. Certain activities that you used to take for granted – e.g., getting up in the middle of the night to go to the washroom – may be surprisingly more challenging for you and you should exercise caution when doing the same – i.e., turn on the lights, take your time and perhaps use a cane or hold onto the wall.
Accurate diagnosis of a specific case of dizziness and balance difficulty after a concussion is important for effective management. These are usually managed the same way dizziness and poor balance is managed for non-concussed patients: vestibular therapy to put it broadly.
It should be noted that balance is also regulated by other factors other than just your vestibular system. Your visual system is also important for maintaining appropriate posture and balance and it too can be adversely affected by a concussion.
It is estimated that over 30% of patients complain of visual symptoms in the first week after a concussion. Other studies have shown that 60% of concussed patients will display oculomotor (muscles of the eyes) abnormalities with the majority of these patients also having symptoms. Suffice it to say, the brain spends a lot of energy processing, coordinating and acting on the images we receive through our eyes. A concussion will often send things awry and correspondingly, patients can complain of blurry vision, double vision, eye strain, shaky images, light sensitivity, motion sensitivity, etc. Often this will result in impairments with reading, computer work and tasks that require focused uniform vision, especially tasks performed near you. These newly offensive activities can cause many symptoms including headaches, neck tightness, fatigue, nausea and malaise and can complicate your recovery. As one may try to compensate for one’s visual deficiencies by spending more time, effort and focus on one of these tasks, say reading for example, there is less energy and focus available for comprehending what one is reading. These can lead one to feel frustrated, further hindering one’s capability for learning and performing meaningful work. Furthermore, visual problems in and of themselves can hinder one’s ability to make memories, both short-term and long-term. Therefore, identifying any visual problems is important to help one recover from the effects of a concussion. Ultimately, some patients will require visual therapy to set things right again.
Some things patients find helpful in coping with visual symptoms is limiting exposure to screens, visually rich or busy environments, fluorescent lighting, bright lights, tasks requiring sustained focus and tasks requiring constantly changing your visual perspective. Some people find it helpful to wear sunglasses, stay in natural lighting, use specific anti-glare screens or simply take frequent breaks and shut their eyes.
Finally, we will make a quick point on some of the hearing-related complaints that can exist after a concussion. These can include tinnitus (a ringing/whistling sound), hearing loss and/or noise sensitivity. Simple strategies you can try at home to manage tinnitus would be to keep some background ‘white-noise’ present to mitigate it. To avoid offending your noise sensitivity, you can try avoiding noisy environments or try using ear plugs. If you experience any of these symptoms, mention it to your healthcare team.