The Audiologist’s Obligation to the Vertiginous Patient
If you’ve ever experienced vertigo, then you’re aware of how horrible this type of dizziness can be. Certainly, talking to a few patients will give you a better understanding of the impact of this symptom on your life. It is incapacitating and there is often a sense of lack of control that can bring on an exacerbating anxiety contribution.
Most audiologists, and frankly many people, have become more familiar with benign paroxysmal positional vertigo (BPPV). There are videos online to help show people how to treat this problem and it is possible to do this successfully. Alternatively, it has been estimated that the annual costs associated with BPPV in the United States exceed $2 billion. How is it that something you can watch on your phone still costs this much to manage?
The reality is that patients (and often health-care professionals) have no idea which ear to treat or treat the wrong type of BPPV with a standard repositioning maneuver. They order many expensive tests (some studies indicate 75 percent of patients with BPPV undergo costly MRI scans). The audiologist is literally in the best position to be able to accurately identify the ear and canal. It should stand to reason, then, that the audiologist is also in the best position to implement the correct management technique to bring about a positive outcome.
Similarly, some would argue that vestibular migraine is one of the most common causes of vertigo and other dizziness. In fact, some recent work suggests that patients diagnosed with other primary causes of vertigo often have vestibular migraine as a secondary diagnosis. The reason for this relationship that appears to exist between vestibular migraine and other causes of dizziness is unknown. What is known is that lifestyle modifications can be very effective in addressing migraine in general.
For example, elimination of triggering food/drink has been shown to cause a significant reduction of migraine symptoms in 63-93 percent of participants. Restful sleep is another factor that seems to improve symptoms of migraine. One study found a 49 percent reduction of headache frequency for the experimental group compared to the control group (25 percent) at six weeks follow-up.
Missing meals or fasting is a trigger in as many as 57 percent of migraineurs. Other researchers have shown that by increasing physical activity through exercise, a 40 percent reduction in migraine headache frequency can be realized. Recommending a “migraine diet” is cited as a first line of intervention in almost all comprehensive articles on management of vestibular migraine. This is a helpful management technique that can be provided by audiologists to the benefit of many patients with this type of migraine.
Management of vestibular impairment is in our scope of practice. By intervening as one of the front-line health-care providers who work with patients with dizziness and imbalance, we can create improvement for the individual. This will decrease the burden of health-care costs, lost days of work, etc.
After attending the Practice Management Specialty Meeting, you will be ready to identify and manage all types of BPPV and provide an initial solution to many patients with vestibular migraine.
About the Presenter
Richard A. Roberts, PhD, is vice chair of clinical operations and an assistant Professor in the Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
Learn more from his presentation at the Academy’s Practice Management Meeting, January 9-11, 2020, in Hawaii:
"The Audiologist’s Obligation to the Vertiginous Patient".