Vestibular dysfunction after mild traumatic brain injury: A systematic review

Abstract

Objective: Vestibular system dysfunction (VD), a condition characterized by impairments in balance, spatial orientation, and eye movement control, is frequently encountered after mild traumatic brain injury (mTBI). We reviewed the existing literature on the various forms of post-traumatic VD and discuss the epidemiology and natural history, diagnostic methods, assessment tools, and therapeutic interventions crucial to identifying and managing these impairments. Method: We examined diagnostic techniques, therapeutic strategies, and outcomes reported in the literature on patients with mTBI with VD. Studies were excluded if they did not address VD resulting from mTBI or if they focused primarily on post-concussion syndrome. Results: Of the 927 studies screened, 59 met the inclusion criteria. Although most research prioritized symptom alleviation, some evaluated outcomes after treatment. Common vestibular symptoms identified included dizziness, imbalance, headache, postural and gait disturbances, vertigo, vestibulo-ocular dysfunction, hearing loss or tinnitus, and nystagmus. Diagnostic methods comprised various techniques, including diverse clinical assessments and specialized vestibular tests, and therapeutic strategies included vestibular rehabilitation therapy and pharmacological treatments, leading to varied clinical outcomes and quality-of-life improvements. Conclusions: The current approaches to diagnosing, assessing, and treating VD in patients with mTBI underscore the importance of a multidisciplinary approach with targeted therapeutic strategies to effectively manage this complex and heterogeneous condition. Further research is needed to investigate the complex interplay between VD and neuropsychiatric symptomology.

Keywords: Vestibular dysfunction; mild TBI; traumatic brain injury; vestibular impairment; vestibulopathy.