For over 30 years, Dr. Glenn Knox, MD, has practiced as a health care provider primarily located in Jacksonville, Florida. Knox is double board certified in otolaryngology and neurotology. Currently, Dr. Knox is a clinical associate professor at the University of Florida. We sat down with Dr. Knox to discuss his work as an expert witness.
AALM: Tell us a little bit about your medical practice and your experience as an expert witness.
GK: I have extensive surgical and medical experience when it comes to the treatment of the ear. I have special interest in tinnitus, cholesteatoma, hearing loss, dizziness and facial paralysis. I have given 11 depositions in these types of cases.
AALM: Tell us what sort of cases involve treatment of the ear.
GK: Motor vehicle accidents can, of course, result in airbag deployment. You may not know that airbags are a common cause of ear injuries. If an airbag goes off, an extremely loud sound is generated. This is true of any airbag, even ones that are not defective. This sound is so loud it is like an explosion. This can result in hearing loss and tinnitus which may be permanent.
AALM: Are other ear injuries possible in motor vehicle accidents?
GK: Yes. Any head injury can be complicated by ear injuries. The head injury can result from a direct impact with the car’s interior. Head injuries can also result from simple deceleration. The victim can be wearing a seatbelt, not lose consciousness, and still have an ear injury. It is also possible in these cases that X-rays, CT scans, and MRIs can be completely normal.
AALM: Are there distinct types of injuries?
GK: Yes. There are three main categories. They can occur singly or in combination. Dizziness can occur if delicate membranes in the inner ear are damaged. For example, the semicircular canals are particularly susceptible to injury. Hearing loss and tinnitus can result from a similar mechanism of damage to a different part of the ear, the cochlea.
AALM: Are there complicating factors in these injuries?
GK: Yes. The inner ear and brain are connected by two nerves. Either the nerves are injured or the brain itself can be injured leading to ear symptoms. These problems can be easily overlooked in head trauma cases.
AALM: Can these injuries and symptoms be permanent?
GK: Yes, in many cases. This can occur even without obvious skull fractures. Of course, if the part of the skull that is fractured contains the inner ear structures, particularly severe symptoms can result. Eardrum injuries and leakage of cerebrospinal fluid can occur. Facial paralysis can also result since the facial nerve is intimately associated with the inner ear.
AALM: What type of tests can be performed to defend against claims related to ear problems?
GK: For claims related to hearing loss, if you are able to find a pre-accident audiogram that can be very helpful. For claims of dizziness, obtaining tests of balance function (vestibular testing) such as VNG and/or posturography is ideal. Also, for hearing and balance, one should thoroughly analyze the plaintiff’s testimony for clues. Tinnitus is difficult to prove but an audiogram with tinnitus matching can help. Otherwise, the plaintiff’s testimony can help.
