Social Support and Family Resilience Among Young and Middle-aged Patients with Coronary Heart Disease: The Mediating Role of Sense of Coherence and Coping Styles.

A traumatic brain injury (TBI) incident even once in a lifetime may introduce several health impacts to the victims, few are appearing immediately such as headache, unconsciousness, body part injury, drainage of cerebrospinal fluid (CSF), hemorrhage, cardiac dysfunction, etc. as a primary outcome of TBI and others, such as Alzheimer's disease, Parkinson's disease, dementia, dystonia, psycho-behavioral abnormality, problem in communication and auditory dysfunctions, are identified later in the life as a secondary post-TBI outcome maybe days or years after the actual scene. A recent literature cited that 0.9% to 58% of TBI victims suffer from hearing loss or any kind of auditory dysfunction. The statistical analysis based on the latest data showed that hearing complexities are 2 – 16 times higher in TBI patients than in individuals without a history of TBI. TBI is known as mild, moderate, and severe based on the severity, clinical abnormalities, and structural changes. A concussion is synonymous with mild TBI caused by a blunt, non-penetrating head impact demonstrating minimum clinical consequences. Severe is the highest level of TBI caused by car accidents, falls, and heavy assault on the head, leading to loss of consciousness for extended periods and lifelong adverse health impacts. Moderate TBI is between mild and severe, where the victim suffers unconsciousness for less than 7 days. All categories of TBI can cause short or long-term hearing impairment. However, which particular TBI causes maximum impact on auditory function is yet to be revealed. Focal and diffuse features of TBI impact may cause discernible adversities to various components of the auditory system, which are directly or indirectly maintaining normal hearing and auditory functions. The latest findings revealed that TBI may affect ear bones in the outer, middle, and inner ear; damage the auditory nerve; and impair cortical regions, which are associated with normal auditory input/output function and response processing. TBI severity on auditory function is not limited to a particular extent; it can be central auditory dysfunction, cochlear impairment, tympanic damage, causing difficulty with normal hearing speech in noise, hypo or hypersensitivity to sounds, loss of postural balance due to CSF drainage or pathologies, tinnitus, and partial or complete hearing loss. TBI impact introduces damage to the inner ear, spinal cord, central auditory system, auditory brainstem, and auditory cortex, which promotes hearing loss. Continuous research findings indicated that hair cell damage and sensitivity loss in the spiral ganglion are associated with TBI outcomes. The complex heterogeneous effect of TBI can cause auditory dysfunction like auditory response processing disorder, cochlear malfunction, neurodegeneration due to hair cell loss, tinnitus, and complex auditory processing, even in the absence of direct linear impact on the auditory system., ,
represents TBI-associated central and peripheral impairment of auditory function. The normal auditory function is mainly performed on receipt of incident sound energy at the external ear, which then transmits through the ear canal, 3 ear bones (malleus, incus, and stapes), oval window, eardrum, and at the tympanic membrane in terms of vibration. The oval window converts the vibrational energy into a fluid wave through the perilymph in the cochlea. The round window works as an outlet to maintain normal fluid pressure. The vibrational mechanism of sound propagation generates a directional flow and proportional pressure gradient following equation , within the perilymph, which activates the intact cochlear hair cells for auditory perception during the signal transfer process.Where P is the acoustic pressure and c is the velocity of sound in the double derivative of the conventional equation above. Traumatic brain injury impact on central and peripheral auditory function. Any change in the pressure velocity gradient is an indication of ear impairment, which sometimes causes little discomfort, such as mild tinnitus. A severe TBI incident causes random drainage of CSF, which reduces the supply of perilymph to the scala tympani and alters the pressure gradient, leading to imbalance and audiometric dysfunction. The latest findings on the mouse model showed that repeated TBI introduced in chronic auditory dysfunction by damaging the spiral ganglion without affecting hair cells, which indicated systematic neuronal damage similar to neuronal death in the brain promoted by TBI. To understand the severity of hearing dysfunction, we may quote the words of the great Helen Keller “Blindness cuts us off from things, but deafness cuts us off from people”. Therefore, greater care should be taken to treat TBI-associated hearing problems as early as possible because there is evidence of auditory dysfunction after childhood TBI. Auditory hallucination was identified in a greater extent of the chronic TBI patients, nearly abou