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Nowadays, the neurosensorial disorders, which appreciably diminuate the quality of the life, are in a continuous increase all over the world.
Table 1 presents the main causes responsible for this phenomenon, as well as the extent to which they influence the increase of each type of neurosensorial disorders.
In Germany during 1992, we had to deal with about 200,000 cases of whiplash injuries due to traffic accidents. Basically, the following types of post-traumatic syndromes due to whiplash injuries can be differentiated, as there does not exist one single disease pattern (Table 2).
Tinnitus occupy a special place between the complaints of the patients suffering from the Late Whiplash Injury Syndrome (LWIS). Tinnitus is an acoustical phenomenon which is perceived without having an extrinsic source of sound. Already in 1994, Claussen has reported the results of a study, which compared the data from 206 cases of late whiplash injury syndrome, who were in medical attention only for treatment purposes, with those from 41 neurootological expertise cases after whiplash injury. In the present work we oncentrated our attention upon those cases of LWIS who were labeled and treated by numerous other doctors and representants of insurance companies as so-called "trifle-cases".
In the third subsample were included those cases who suffered from the so-called Hypersensitive Ear Syndrome (HES) (Claussen 1985).
The audiometrical results then were underpinned through analyses of the acoustical pathway. The subdivision of the main sample from the point of view of the above described criteria is presented in Table 6.
Table 7 shows that in all the samples other sensorial disturbances are considerably present. Table 8 combines the data concerning the hearing disturbances with those concerning the tinnitus.
When analyzing the qualitative characteristics of the ear sensations, the highest incidence of the complaints is found in the sample of patients with maskable tinnitus (Table 9). Two of the 91 patients were notable to make a personal estimation concerning the evolution of their disease.
The results of these complex and sensorial investigations showed that in nearly all the patients tinnitus was not an isolated phenomenon, being mostly associated to other multi sensorial neurootological functional disturbances. As all the cases come to us with a very rich medical, hospital, litigation, and expertise documentation accumulated in the peri od of time following the accident, however, including also pre-accidental patient information, we get comple e information about the evolution of the disease, the inte mediary symptoms and the preexisting medical result and diagnosis. The problem of tinnitus as a consequence of whiplash injury is intensively discussed in the neurootological literature since 1928.
In 1928 tinnitus is ment oned by Barré and Lieou as being the most frequent sym tom in the patients with cervi cospinal injury.
In most of the patients investigated by these authors, tinnitus appears as a result of the so-called "degenerative cervico-spinal injury syndrome". Shulman, who is considered as one of the pioneers and an exceptional specialist in the field of the tinnitus research, shows in his book about the modern diagnosis and therapy of tinnitus, that the severe, disabling tinnitus is usuallly associated with anxiety psychosis.
The observation of Shulman, that in most of the tinnitus cases, there coexists a high tone sensorineural hearing loss, is valid for the patients investigated by us, too. Fürther on, Shulman shows that about 20% of the patients with severe tinnitus also have vertigo complaints.


Based upon the numerous observations from all over the world, concerning the late complications of the whiplash injury, we can affirm that even the simple, non-contact whiplash injury can be the cause of long lasting, cronic polisensorial disturbances. Some of the most frequent sensorineural disorders are the visual disorders, the hearing loss, the tinnitus and the vertigo. The present work presents a certain neurosensorial disorder related to the head, namely the tinnitus of traumatic etiology. The consequences of the trauma can appear immediatel y after the accident, but most frequently, the traumatic incident is followed by a period of more or less clinical silence and the symptoms become evident only after hours, days or months.
The orthopedic as well as the radiological findings mostly are unsatisfactory with respect to the neurosensorial disturbances. Of a special interest for the present work are the disturbances described as the "cervico-encephalic syndrome." This group also frequently follows a whiplash injury. In all the cases, the neurootological disorders were late complications of a whiplash injury. As Table 5 shows, these patients had complaints of the LWIS for a long time, and were repeatedly investigated by many different medical specialists prior of coming to us. The percentage distribution of the most important non-acoustical subjective symptoms in the above described samples of patients is presented in Table 7. The clinical experience showed that in the case of the LWIS, symptoms like otalgia or pressure in the ear may accompany tinnitus. Many patients reported the presence of several complaints and disturbances which we considered as being complications of the tinnitus (Table 11).
The vestibulo-ocular and retino-ocular reactions are investigated by the method of polygraphic electronystagmography and the vestibulo-spinal reaction by cranio-corpo-graphy with simultaneous computer analysis. Because of the medical expertise questioning, a clear differentitation between the disturbances brought about the accident and thos already pre-existing or having other causes must be done for each of the cases. Decher reports in 1966, that 41% of 500 patients with a history of cervico-spinal injury complain of tinnitus. In many cases the disturbances are also caused by vascular problems in the posterior cranial fossa, due to a narrowing of the vertebral artery in the cervical region. Because of their permanent presence, the ear noises often become intolerable and are seriously disturbing the daily personal life. We also frequently find this stato-acoustical combination in our tinnitus patients with a cervico-encephalic syndrome, due to a whiplash injury.
As it was shown above, tinnitus plays a special role in the complex mosaic of these multisensorial neurootological functional disturbances. I must admit, I had not even heard of Jogger before, but when Nosaj Thing is doing a remix I had to this here dreamglitch a shot. The incidence and variety of the head and neck injuries due to traffic accidents have extremely increased in recent years. Statistically, about 80% of the cases with whiplash injuries due to traffic accidents recover within a few months.
Therefore many of these patients are under suspicion of malingering, or their disturbances are considered as being of a psychic type.
They develop as the result of the years long lasting cronification degenerative processes of the lesions induced by the trauma incident.


Likewise, in none of these cases a cerebral commotion or a cerebral concussion could be established after the accident.
Therefore, the audiological investigations by the tinnitus masking method mostly cannot determine the presence of the tinnitus' at the moment of the examination.
Their presence can be due to traumatical changes induced during the accident in the maxillary sinuses, as well as in the temporomandibular joints.
Thereby taken into consideration only hearing losses of perception type, assessed by the bone conduction testing. The vestibulo-vegetative reactions are permanently monitored by a simultaneous EKG-registration. In our study, the multisensorial neurootological disturbances were caused in nearly all the patients, by the whiplash injury (Table 16). The degree of the psychical impairment is directly depending on the intensity of the tinnitus.
By means of the modern functional neurootological network analysis we can contribute much to clarify and to verify the disabling complaints which appear in the late whiplash injury syndrome.
By using seat belts, shoulder harnesses and head rests the amount of direct wounds and fractures are reduced in modern motor vehicles. Problems of evidence also arise in compensation claims calling for an additional neurootological medical expertise. By means of the modern functional neurootological network analysis we can nowadays contribute much to clarify and to verify the disabling complaints of the late whiplash injury syndrome. These cases were classified and treated as "trifle-and minor-traumas" by all the doctors and experts who have seen them prior to him. This is very important on one side for the medical expertise and on the other hand for the correct diagnostic and therapeutical evaluation of these patients. However, the energy impact upon a person, sitting in a car involved in a traffic accident of the surprise-rear-end-collision type, is absorbed in the head and neck through an abrupt hyperextension and hyperflexion movement, which also is called the whiplash injury mechanism. Once more it reflects the uncertainty of the doctors as it concerns the neurosensorial disturbances, and appeared as late complications of the whiplash injury.
For this Dutch team, the neurootological investigations are of an exceptional importance for a correct judgement of the patients with whiplash injury, as namely they can reveal the long lasting degenerative and cronification processes following the trauma.
These abrupt movements of the head and neck may have several morpho-functional consequences upon the cervical region, as well as upon the nervous and sensorial structures of the head.
The characteristics of the ear noises were specifically investigated through the tinnitus masking method.
Their studies and conclusions are based upon the numerous pathological electronystagmographical findings, and also the corresponding pathological audiological results. The state of the acoustical pathways was investigated by means of the acoustically evoked brain stem potentials as well as the acoustically evoked late (cortical) potentials.



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