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The Ear in Head Trauma
Criteria of vestibular disturbances of central origin in closed cranial injuries are difficult to determine, according to Despons,52 and investigators do not agree as to differential signs between these and peripheral disorders. Accidents resulting in coma of varying duration indicate the probability of a cerebral disturbance, but absence of coma or loss of consciousness does not exclude the possibility of central sequelae. Such injuries are not always proportionate to the severity of the trauma. If there is no cochlear involvement, e.g. buzzing or hearing loss, a strictly labyrinthine cause is doubtful. Subjective complaints are of little value in differentiation. Functional disorders, such as impaired balance and difficulty in walking are more significant. Persistence of these symptoms for several weeks or months after injury would suggest presence of a central lesion. Spontaneous nystagmus has great diagnostic value. Nystagmus which is