Vestibular disorders in blast injuries. The role of growth hormone

Abstract

The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as a consequence of a blast injury, we have done present investigation. One hundred and ten patients were examined: 65 Anti-Terrorist Operation (ATO) participants with mild traumatic brain injury (mTBI), 44 non-ATO plus one patient with acromegaly was examined using posturography. Questionnaire “Types of Dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, showing that this complaint is not specific to mTBI. Objective vertigo (sensation of the subjects moving around the patient) was detected in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. Thus, we have two different qualitative groups. So, these complaints are specific to the patients, who survived blast injury. Complaints of subjective vertigo are also typical for those with blast injury. Complaints of pseudovertigo are specific to the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific to the people with blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) have been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not typical for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been revealed in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients; this complaint is not specific to mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is detected in 20 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. It is also an interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific to the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control). The results are discussed from the point of view of a severe vestibular disorder due to the blast injury. The tallness correlated with drop attacks (R29.6 according to ICD-10, the nosology is missing in the Ukrainian translation), it is suggested that growth hormone might cause the fluctuation of vestibular function. Conclusions. 1. ATO participants have pronounced vestibular disorders. 2. Patients with mTBI (ATO participants) experienced severe stress. 3. Signs of vestibular dysfunction such as complaints of objective and subjective vertigo, kinetosis differed quantitatively and qualitatively, therefore, being specific to the ATO participants. 4. Pseudovertigo, claustrophobia, descendophobia differed only qualitatively. 5. Dizziness, loss of consciousness, orthostatics, agoraphobia differed only quantitatively. 6. The tallness of patients with mTBI correlated with complaints of drop attacks, both quantitatively and qualitatively. 7. In statistical studies, it is important to use Fisher’s matrix test.