PP1101 - Assessment of Mild Traumatic Brain Injuries in Pediatric Audiology at Nemours Children's Health

Abstract:
With the growing need for effective care of mild Traumatic Brain Injuries (mTBIs), the understanding of how concussions can impact the pediatric population has never been more important. Children are at higher risk of obtaining a mTBI, and care for these individuals requires a multidisciplinary approach. Audiology is one field that can provide an in-depth understanding of how concussions can impact hearing, balance, and higher auditory functioning. This presentation looks at how concussions impact a child’s life, the importance of having a concussion-focused test battery, and various case studies from Nemours Children’s Health in Wilmington, Delaware.

Summary:
Traumatic Brain Injuries (TBIs) can cause a multitude of short-term and long-term symptoms that impact an individual’s ability to participate in their community along with their overall quality of life. By definition, a concussion is a diffuse, nonpenetrating TBI caused by an external force, and is typically categorized as a “mild TBI” or mTBI (AAA, 2018). Within recent years, concussions have been a topic of discussion across many professional fields, particularly as it relates to sports-related trauma. Among the world’s population, children are at higher risk of getting injured and obtaining a concussion. For example, within the United States in 2020, the likelihood of a child experiencing symptoms of a concussion increases with age. This includes 2.0% of 0–5-year-olds rising to 5.8% of 6–11-year-olds rising to 12.2% of 12–17-year-olds experiencing symptoms. Possible causes may be due to children spending more time doing activities with increased risk (i.e., sports), having less ability to judge risk, and having greater impulsivity when compared to the adult population (Mayoclinic, 2019).

Care for pediatric patients who experience a mTBI can be complicated and may require a multidisciplinary team to support them. Symptoms of concussions can vary dramatically and often depend on the level of severity (i.e., mild to severe) and the location of the injury. In accordance with the American Academy of Audiology (2022), there are four classifications of symptoms including cognitive impairments (i.e., concentration difficulties), physiological impairments (i.e., blurry vision), emotional problems (i.e., sadness, depression), and sleep disturbances. Based on the diversity of symptoms and experiences, recovery looks different for everyone. Children and adolescents cause additional challenges with their recovery due to needing physical and cognitive rest periods that require them to take time away from school and sports, which can be academically detrimental and socially isolating (Refakis et al., 2017).

Within the field of audiology, continuous research is being done on the impact concussions have on the peripheral and central auditory systems. Often, children who have experienced a mTBI report decreased hearing, difficulty following directions, dizziness, tiredness, and difficulty understanding speech in noise. Symptoms may be more obvious with a perforation of the tympanic membrane, tinnitus, or shifts in audiometric thresholds. It can even cause more balance-related dysfunctions, influencing the semicircular canals or the otolith organs. However, concussions could cause symptoms to be more hidden. This may create difficulties with auditory processing, listening in background noise, temporal pattern perception, and auditory fatigue.

With the varying symptoms and increasing frequency of mTBIs, the importance of establishing a consistent test battery as it relates to a patient’s symptoms has never been more important. The goal of this poster is to demonstrate the impact mTBIs have on a child’s life, showcase diagnostic tools that may be helpful when working with these patients, and provide various case studies of patients who have experienced a mTBI at Nemours Children's Health in Wilmington, Delaware.