From the Guidelines
Concussions can cause temporary hearing changes and pain that should be addressed with a multi-faceted approach, prioritizing active management and treatment of persistent postconcussion symptoms (PPCS) through individual disciplines and interdisciplinary rehabilitation, as recommended by the latest guidelines 1. When managing auditory changes and pain associated with a concussion, it is essential to consider the potential effects on the brain's auditory processing centers and inner ear structures.
- Hearing changes can be addressed by resting in a quiet environment for 24-48 hours after injury, avoiding loud noises, and using ear protection if necessary.
- For pain control, starting with acetaminophen (Tylenol) at 650-1000mg every 6 hours, not exceeding 4000mg daily, is recommended, while avoiding NSAIDs like ibuprofen or aspirin for the first 24-48 hours due to the increased bleeding risk 1. After this initial period, ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours with food can be used if needed, along with applying cold packs to painful areas for 15-20 minutes every 2-3 hours during the first 48 hours. Key aspects of management include:
- Ensuring adequate rest and hydration
- Gradually returning to normal activities following healthcare provider guidance
- Monitoring for persistent or worsening symptoms, such as severe headache, repeated vomiting, seizures, or increasing confusion, which require immediate medical attention. The importance of active management and treatment of PPCS is highlighted by the findings of a systematic review and meta-analysis, which emphasizes the need for more methodologically robust research in this area 1.
From the Research
Auditory Changes and Pain Management Strategies
- Concussion, a form of mild traumatic brain injury, can disrupt brain function and lead to persistent post-concussive symptoms (PPCS) [ 2 ].
- Vestibular and oculomotor dysfunction are among the most debilitating impairments associated with PPCS [ 2 ].
- Non-pharmacological interventions, such as vestibular rehabilitation, optokinetic stimulation, and vestibulo-ocular reflex exercises, have been examined for the treatment of vestibular and oculomotor dysfunction in patients with PPCS [ 2 ].
Management of Concussion and PPCS
- Management of concussion and PPCS relies on identifying underlying symptom generators, and treatment options include sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, pharmacological management, or a combination of treatments [ 3 ].
- Evidence-based treatments have emerged to treat post-concussion symptom generators for sport-related concussion and for patients with PPCS [ 3 ].
Cognitive Behavioral Therapy for PPCS
- Cognitive behavioral therapy (CBT) has been considered as a treatment for persistent post-concussional symptoms, taking into account the relative lack of symptom specificity, the extent to which subjective cognitive difficulties predominate, and the role of psychological processes in the evolution and maintenance of symptoms [ 4 ].
- CBT may be effective in the treatment of postconcussion syndrome, although further rigorous trials are required [ 5 ].
Vestibular Rehabilitation Therapy for Concussion
- Vestibular rehabilitation therapy (VRT) has been evaluated for its efficacy in patients with concussion, with some studies reporting improvement in outcomes [ 6 ].
- However, the current evidence for optimal prescription and efficacy of VRT in patients with mild traumatic brain injury/concussion is limited, and further high-level studies are required [ 6 ].