My husband was in a car accident and got hit on the side of the head. Now he has a balance problem and a ringing in his ears all the time. He was told that it might or might not correct itself. Do we leave it at this or look for further help from someone? It has affected his everyday life.

D.Y.

Your husband most likely suffered from a labyrinthine concussion. The inner ear is sometimes referred to as the labyrinth (maze), since it is composed of an elaborate system of interconnected, tube-like, fluid-filled chambers. The labyrinth includes the organ for hearing (the cochlea) as well as the organs for balance. The ringing in his ears (also known as tinnitus) demonstrates that he sustained a cochlear injury. He may have also lost some hearing as a result of his injury.

The labyrinth is surrounded by a bone, known as the temporal bone. Your husband may have struck his head hard enough to fracture this bone. Temporal-bone fracture can certainly include all of the symptoms of a labyrinthine concussion (balance problems, tinnitus and hearing loss). If your husband had a CT scan of his head, this CT may have revealed such a fracture.

What's a concussion? Concuss means "to shake or jolt." Concussion is an injury due to shaking. Some tissues, such as the delicate neurons (nerve cells) of the inner ear or brain, do not fare particularly well with vigorous shaking. Depending upon the severity of the injury, these cells may or may not recover. Temporal-bone fracture is a more serious injury than simple concussion, and it is more likely to be associated with permanent injury to the inner ear.

Your husband's prognosis for spontaneous recovery depends greatly on the severity of the injury (was it a concussion or a fracture?) and on the time that has passed since the injury. If the accident was just a few days or weeks ago, then there is still a good chance that he may improve significantly, with time. If the accident occurred months ago, then the prospects are more dismal.

Tinnitus and hearing loss are, unfortunately, often permanent. There are many ways to help someone with tinnitus, but there are no "sure cures." Some forms of hearing loss may improve with surgical intervention, while other forms (such as ensorineural hearing loss, or nerve deafness) can be improved only by use of a hearing aid. Certainly, your husband needs to see an ear, nose and throat doctor (ENT) in order to have his hearing tested and to discuss possible treatment of his tinnitus (and hearing loss, if present).

The balance problem can also be treated. Here, too, an ENT would be helpful. Your husband should ask his ENT about vestibular rehabilitation, a form of physical/occupational therapy that is designed to strengthen an injured vestibular (balance) system. Vestibular rehabilitation works. Anti-dizziness medications only mask the problem and should be avoided as much as possible.