Purpose:
Patients with binocular vision dysfunction (BVD) have vestibular symptoms (dizziness, nausea, gait abnormalities) as well as headache/head pressure, neck pain, anxiety and unclear vision. Treatment of BVD with glasses containing micro-prism lenses often reduces these symptoms. One cohort of patients with traumatic brain injury (TBI) did not improve as expected, and all admitted to hyperacusis. This study’s purpose is to demonstrate reduction of residual symptoms with noise cancelling devices.
 
Methods:
This retrospective study includes 23 patients with TBI presenting for annual vision examination, previously diagnosed with BVD and treated with glasses containing micro-prism lenses for >1 year, who had residual vestibular and BVD symptoms and who admitted to hyperacusis. Baseline data included completion of the modified Khalfa questionnaire, and subjective 0-10 scoring of headache, neck pain, dizziness, unsteadiness walking, nausea, anxiety and light sensitivity. Sound cancelling earbuds or headphones (Bose QC 30 earbuds or QC 25 headphones) were placed upon the patient and subjective symptom scoring was repeated. Then the vision examination was performed with the patient wearing the noise cancelling device. Post-examination, subjective symptom scoring was repeated with both the updated vision prescription and noise cancelling device in place.
 
Results:
65% of patients had moderate to severe hyperacusis. All subjective symptom scores decreased markedly including dizziness (58.4%), nausea (63.3%), and unsteady walking (76.6%). Over 90% of symptom reduction was due to noise cancellation, with <10% due to micro-prism lenses.
 
Conclusions:
In patients with TBI previously diagnosed with BVD and previously treated with glasses containing micro-prism lenses, who had residual vestibular and BVD symptoms and who admitted to hyperacusis, amelioration of the hyperacusis using noise cancelling devices resulted in marked reduction of the residual symptoms.

Amelioration of hyperacusis impacts vestibular symptoms and binocular vision dysfunction symptoms in patients with traumatic brain injury