Normal Hearing Tests but Struggling with Speech Clarity After Accident

Hearing tests are normal, but there is still difficulty in clearly hearing the articulation of words?

Hello Doctor: I was in a car accident before the Lunar New Year this year, and after lying on the ground, I started experiencing dizziness, headaches, and nausea as soon as I arrived at the emergency room.
Since then, I have had several episodes of tinnitus, and during the New Year, after experiencing tinnitus in my right ear, I pressed my ear hard with my hand and clear fluid came out.
In the past week, I have had four instances of very slight nosebleeds.
I underwent three tests in the otolaryngology department, all of which were normal.
During one of the tests, I had to lie down and turn my head all the way to the left, which caused me to start feeling dizzy again, and I have been dizzy for a week.

1.
Doctor, how long can mild concussion-related dizziness last? The dizziness worsens with the side effects of the medication I am taking.

2.
The pure tone audiometry and the other two tests in the otolaryngology department were normal, but in real life, I struggle to catch words when people speak too quickly.
I can hear them, but my brain doesn’t absorb the information, and I still only understand partially.
I also need to ask the person on the phone to slow down.

3.
The neurologist said my auditory nerve is normal.

4.
The ear, rehabilitation, and traditional Chinese medicine departments lean towards a diagnosis of brain injury.
What should I do now?

Ke Ke, 40~49 year old female. Ask Date: 2023/02/25

Dr. Zheng Jueyi reply Otolaryngology

Hello, if you have already undergone an ENT examination with normal hearing and a neurology evaluation showing normal auditory nerve function, it is recommended to continue rehabilitation therapy and have regular outpatient follow-up examinations.

Reply Date: 2023/02/25

More Info

It sounds like you are experiencing a complex set of symptoms following your car accident, and I understand how concerning this can be. Let's break down your situation and address your questions systematically.

1. Duration of Dizziness After a Mild Concussion: After a mild concussion, dizziness can vary in duration depending on the individual and the severity of the injury. Generally, symptoms like dizziness can last from a few days to several weeks. If you are experiencing prolonged dizziness, it is essential to follow up with your healthcare provider. The medications you are taking may also contribute to your dizziness, especially if they have side effects that include dizziness or sedation. It is crucial to discuss these side effects with your doctor, as they may need to adjust your medication or explore alternatives.

2. Normal Hearing Tests but Difficulty with Speech Clarity: It is not uncommon for individuals who have experienced a concussion or head injury to have difficulty processing auditory information, even if their hearing tests return normal results. This phenomenon is often related to how the brain processes sound rather than an issue with the ears themselves. The brain's ability to interpret and understand speech can be affected by the injury, leading to challenges in following conversations, especially in noisy environments or when people speak quickly. This condition is sometimes referred to as "auditory processing disorder" (APD). It may be beneficial to engage in auditory rehabilitation or speech therapy to help improve your processing skills.

3. Normal Auditory Nerve Function: The fact that your auditory nerve is functioning normally is a positive sign. It indicates that there is no significant damage to the structures responsible for transmitting sound signals from the ear to the brain. However, this does not rule out the possibility of cognitive or processing issues stemming from the concussion.
4. Consulting with Specialists: Given the complexity of your symptoms, it may be beneficial to continue consulting with specialists. A neurologist can assess for any lingering effects of the concussion, while an audiologist can provide further evaluation of your auditory processing abilities. Additionally, a speech-language pathologist can work with you on strategies to improve your comprehension and processing of spoken language.

5. Next Steps: Here are some recommendations for your next steps:
- Follow-Up with Your Neurologist: Discuss your ongoing symptoms, including dizziness and difficulty with speech clarity. They may recommend further imaging studies or assessments to rule out any other underlying issues.

- Audiological Evaluation: Consider a comprehensive evaluation by an audiologist who specializes in auditory processing disorders. They can provide specific tests to assess how well your brain processes auditory information.

- Speech Therapy: Engaging in therapy with a speech-language pathologist can help you develop strategies to improve your understanding of speech in various contexts.

- Monitor Your Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any triggers you notice. This information can be invaluable for your healthcare providers in tailoring your treatment plan.

In conclusion, while your hearing tests are normal, the challenges you are facing with speech clarity and ongoing dizziness are valid concerns that warrant further investigation and intervention. It is essential to maintain open communication with your healthcare providers and advocate for the support you need to navigate your recovery effectively.

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