Diagnosis of Tinnitus Due to Auditory Radiation Injury Following Whiplash Injury: A Case Study

Abstract

We report on a patient with tinnitus who showed injury of auditory radiation following whiplash injury, demonstrated by diffusion tensor tractography (DTT). A 48-year-old male patient suffered from a car crash resulting in flexion-hyperextension injury of his head after being hit from behind by a moving car while waiting at a signal while driving a car. Three days after the car crash, he began to feel tinnitus in both ears and his tinnitus became aggravated with the passage of time. No specific lesion was observed on a conventional brain MRI performed two weeks after the car crash. Although he visited several hospitals, the precise cause of his tinnitus was not detected. Two years after the car crash, he underwent evaluation for his tinnitus at the ear, nose and throat department of a university hospital. The pure tone audiometry was evaluated in a sound-proof room to screen his hearing status for the frequencies of 250–8000 Hz and no specific abnormality was detected. Although he was also tested for speech audiometry, there was also no specific abnormality. In order to assess his tinnitus, a tinnitogram was conducted to evaluate the frequency content and the loudness. His tinnitus was characterized at an intensity of 40 dB and a frequency of 4000 Hz. However, no abnormality was observed in either ear on physical examination. On DTT, the auditory radiation showed severe narrowing and tearing in both hemispheres. To summarize, neural injury of the auditory radiation was demonstrated in a patient with tinnitus following whiplash injury, using DTT.