Labyrinthine concussion

Labyrinthine concussion is an injury to the inner ear (the labyrinth) caused by a blow or jolt to the head. It can cause vertigo, imbalance, hearing changes and ringing in the ear, and it often happens alongside a brain concussion. One of the most common inner-ear problems after a head injury is BPPV — loose inner-ear crystals that cause brief spinning with head movement — which can usually be treated with repositioning manoeuvres. Vestibular physiotherapy has a strong role here, using targeted manoeuvres and exercises to help the inner ear and brain recover. At McKelvie Physiotherapy in Pickering, we assess exactly where your dizziness is coming from and coordinate with your family doctor on your concussion care.

What is labyrinthine concussion?

Your labyrinth is the inner ear — the delicate system of fluid-filled canals and sensors that controls both hearing and balance. A labyrinthine concussion is an injury to this system caused by a blow or jolt to the head, without a skull fracture through the inner ear.

It often happens alongside a brain concussion, which can make it hard to tell where symptoms are coming from. That matters, because inner-ear problems after a head injury are often very treatable — but only once they’re properly identified.

What causes labyrinthine concussion?

Labyrinthine concussion follows head trauma — commonly a fall, a sports injury or a car accident. The force of the impact can:

• Loosen the inner ear’s calcium crystals, which drift into the balance canals and cause BPPV — brief spinning when you lie down, roll over or look up
• Injure the balance sensors or nerve, reducing how well one inner ear senses head movement
• Affect the hearing organ, causing hearing loss or ringing in the ear

In a systematic review of research on inner-ear problems after traumatic brain injury, BPPV was the most frequently identified inner-ear diagnosis (Šarkić et al., 2021). Post-traumatic BPPV can also affect more than one canal or both ears, which is why careful testing matters.

What are the symptoms of labyrinthine concussion?

• Vertigo — including brief spinning when you change head position
• Imbalance or unsteadiness when walking
• Dizziness or blurred vision when you move your head
• Discomfort in busy visual environments such as grocery stores or traffic
• Hearing loss, muffled hearing or ringing in the ear
• Nausea
• Headache, fatigue or difficulty concentrating, which may also reflect the brain concussion

How is labyrinthine concussion treated?

Your family doctor should be your first stop after a head injury, to rule out serious injury and guide your overall concussion recovery, including your return to work, school, driving or sport. If hearing loss or complex inner-ear symptoms are present, they may also refer you to an ENT specialist.

Vestibular physiotherapy has a strong role in recovery, and a clinical practice guideline for physical therapy after concussion recommends assessing and treating vestibular and oculomotor problems, including BPPV (Quatman-Yates et al., 2020). Depending on what we find, treatment may include:

• Canalith repositioning manoeuvres for post-traumatic BPPV, matched to the affected ear and canal
• Gaze stability exercises to help the brain adapt if one inner ear isn’t sensing movement well
• Balance and walking training to restore steadiness and confidence
• Habituation exercises to reduce sensitivity to head movement and busy visual environments
• Neck treatment when a neck injury from the same incident is adding to dizziness
• A graded return to activity, paced to your symptoms and coordinated with your doctor

1. 01

   Pinpoint

   Positional testing with infrared goggles plus balance and eye-movement tests to separate inner-ear, brain and neck causes of your dizziness.

2. 02

   Treat

   Repositioning manoeuvres for any post-traumatic BPPV, and targeted gaze, balance and habituation exercises for the rest.

3. 03

   Return to activity

   A graded plan back to work, school, sport and daily life, paced to your symptoms and coordinated with your family doctor.

Why choose McKelvie Physiotherapy for labyrinthine concussion?

• Led by an Advanced Vestibular Physical Therapist (AVPT) — dizziness and balance are our clinical focus.
• Advanced diagnostic technology — we use infrared video goggles (video-oculography) to record eye movements the naked eye can’t see, so your diagnosis is based on evidence, not guesswork.
• Nothing missed — we check for post-traumatic BPPV and other inner-ear problems.
• One-on-one care in private rooms — every session is with your physiotherapist.
• Coordinated care — we work alongside your family doctor and closely with local ENT specialists.
• Care that comes to you — in person in Pickering, at home across the GTA, or virtually anywhere in Ontario.
• Direct billing to many major insurers — and no referral needed.