Neurootological contributions to the diagnostic follow-up after whiplash injuries

Only in 1992 we had to deal with about 197,731 cases of whiplash injuries due to traffic accidents on the roads of Germany. About 80% recover within a few months. However, about 15%-20% develop the so-called late whiplash injury syndrome with many complaints of the cervico-encaphalic syndrome including headache, vertigo, instability, nausea, tinnitus, hearing loss etc. The orthopedic as well as the radiological findings are mostly unsatisfactory with respect to the neurosensorial complaints. Therefore problems of evidence arise in compensation claims calling for additional neurootological medical expertise. When analysing 124 expert examinations of our patients suffering from late whiplash injury syndrome we found that the average case had already seen 3.83 medical experts elsewhere including 18 different medical specialities. At the most, we observed 17 expertise visits/case prior to the patients visit to us. In the present study we compared the results from 42 neurootological expertise cases with 206 cases of late whiplash injury syndrome, who only came for treatment purposes to our neurootological practice. Al our patients underwent a systematic history (NOASC I) and a functional neurootological, audiometric and equilibriometric examination. Thus we tried to assess the location and nature of the functional degeneration underlying the posttraumatic residual vertigo symptoms, etc. The objective and quantitative equilibrium investigations included several ENGs and an analysis of the cranio-corpo-gram, thus obtaining a record of the gait and standing patterns by means of a radar-like image of the marker tracings from the head and the shoulders during stepping and standing, as well as during bending, extending and turning the neck (computer CCG). Thus individual patterns of functional lesions in the neurootological pathways can simultaneously? objectively and quantatively be worked out for both the groups confirming the subjective complaints.