Objective Audiovestibular Assessment After Traumatic Brain Injury in Medico-Legal Contexts: A Narrative Expert Review and Practical Cross-Check Framework

Post-traumatic auditory and vestibular complaints are frequent after traumatic brain injury (TBI) and temporal bone trauma. They create particular difficulty in medico-legal practice because the evaluator must distinguish diagnosis, functional impact, plausibility of traumatic causation, and the credibility of reported deficits and/or symptoms. This manuscript is a narrative expert review, not a systematic review or a validated forensic prediction rule. It aims to synthesize clinically relevant evidence and propose a practical cross-check framework for structured audio-vestibular assessment in post-traumatic and medico-legal contexts. Pure-tone audiometry remains the functional entry point, but it should be interpreted in conjunction with speech audiometry, tympanometry, acoustic reflexes, transient-evoked and distortion-product otoacoustic emissions, auditory brainstem responses, and auditory steady-state responses. Vestibular evaluation should combine videonystagmography, video head impulse testing, cervical and ocular vestibular evoked myogenic potentials, and computerized dynamic posturography, recognizing that each method interrogates different physiological domains and frequencies. Particular emphasis is placed on the separation between clinical diagnosis, physiological localization, functional impairment, and medico-legal attribution. The article also discusses safeguards against false-positive attribution of malingering, the time course after TBI, inter-rater variability, and the role of specialist expertise in medico-legal reporting. The proposed framework does not eliminate uncertainty; rather, it is intended to make expert reasoning transparent, cautious, internally consistent, and defensible.