Balance/Vestibular

Balance/Vestibular

Public Relations Outreach Efforts: A Year in Review (October 2018- September 2019)

October is Audiology Awareness Month and we want to take this opportunity to showcase the media coverage to include audiology coverage, as well as that of our members over the past year.

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CODING AND REIMBURSEMENT | Billing and Coding the Vestibular Evaluation

The vestibular evaluation can include a number of different procedures, and coding for these evaluations can often be confusing. There are several current procedural terminology (CPT®) codes that should be considered when completing your evaluation.

Topic(s): Coding, Reimbursement, Balance/Vestibular, Audio-vestibular/Audiovestibular, vestibular evaluation, dix-hallpike maneuver, positional nystagmus test, caloric irrigation, cervical vestibular-evoked myogenic potential (cVEMP), optokinetic nystagmus test, oscillating tracking test, spontaneous nystagmus test, sinusoidal vertical axis rotation testing, computerized dynamic posturography

Yes Hearing Aids, No Dementia, Depression, and Falls

We have heard the concerning connections between untreated hearing loss and a host of other health conditions. There is always debate around these conversations about whether the link between hearing loss and say accelerated dementia is causal or otherwise.


One of the tried and true methods to ask this question more deliberately is to reintroduce function, hearing in this case, and observe the effects on the secondary conditions.


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Academy Supports Balance Awareness Week

The Academy is proud to help support Balance Awareness Week—September 15–21, 2019. Balance Awareness Week, an observance designated by the Vestibular Disorders Association (VeDA), aims to increase awareness about vestibular disorders and support patients in their journey back to balance.

While many balance disorders are incurable, faster and more accurate diagnosis, along with effective coping strategies can greatly improve quality of life.

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Audiology Today Sept/Oct 2019…What’s Inside This Issue?

Take a look at the table of contents and delve into these online articles, which you can now easily search by topic, title, or author. 

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AUDIOLOGY ADVOCATE | Time to Activate to Advocate

With the 116th Congress already over a quarter under way, the Government Relations Committee (GRC) urges Academy members to get involved. It is an exciting time for audiology, with the Academy actively working and collaborating with other organizations on new policy initiatives. The audiology voice in numbers is critical for the profession in advancing these initiatives.

Topic(s): Advocacy, Patient care, Hearing, Hearing Aids, Hearing Loss, Healthcare, Medicare Audiologist Access and Services Act, Centers for Medicare and Medicaid Services (CMS), Medicare, Balance/Vestibular, Adult

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Our Responsibility to Move Audiology Forward

A culture of quality is needed if we are to bring audiology into the spotlight and highlight our expertise in hearing and balance. Ritz-Carlton co-founder and former president Horst Schulze states that we can create transactions every day, but until we place the person next to us as the most important person in the world in that moment, we will never create an experience.

Topic(s): Professional, Patient care, Public Awareness, Centers for Medicare and Medicaid Services (CMS), Coding, Reimbursement, Practice Management, Hearing Assistive Technologies (HAT), Balance/Vestibular, Hearing Aids, Hearing Health Care

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Publication Issue: Audiology Today September/October 2019

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KNOW HOW | Changing Times Will Revitalize Audiology Services

Audiology services and provisions are changing following the passage of the over-the-counter (OTC) hearing aid legislation. In the end, what that will actually mean is still unclear. Likely, we will see a device that can manage mild hearing loss for patients and give them some options for their hearing health care. Those of us who have practiced for many years are still trying to decide how that will fit into our current practice model and whether to incorporate an OTC product in the clinic. 

Topic(s): Patient care, over-the-counter (OTC) hearing aid devices, Audiometric Test, Tinnitus, Cochlear Implants (CI), Hearing, Balance/Vestibular, speech-in-noise, Bluetooth, Professional

JAAA Latest Fast Track Articles—August 20, 2019

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Ask the Expert: Concussion

Ask the Expert: Concussion

Physical Therapist: Shelly Massingale, PT, MPT

1. Concussion has received significant media attention over the last few years. What is a concussion? 

The CDC defines concussion as “a type of traumatic brain injury or TBI- caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.”  Concussion is commonly referred to as a mild traumatic brain injury (mTBI) and is typically associated with normal structural imaging (normal CT/MRI). Symptoms of concussion  can include dizziness, headache, cognitive changes, mood changes, balance problems, and nausea and vary from person to person and from injury to injury.  Concussion is considered a transient injury that typically lasts a few days to a several weeks before full recovery.  

2. Dizziness and balance problems are common after concussion. Why are these symptoms so common?

Dizziness and balance problems that occur after a head injury are often the result of damage to either the peripheral or central vestibular system.  Our vestibular system is comprised of our inner ear (peripheral vestibular system), the vestibular nerve (connects the peripheral to the central vestibular system), and the areas in the brain that process that information (central vestibular system).  If any of these areas have been affected, the injured person could experience feelings of dizziness, being off balance, vertigo or a combination of these.  Our vestibular system is highly sensitive to movement, so any damage or disturbance to these areas cause symptoms while performing activities of daily living. 

3. Do you recommend that patients pursue vestibular rehabilitation after a concussion?

If a patient sustains a concussion and has any symptoms of dizziness, vertigo, imbalance, or nausea that last more than a few days, I highly recommend pursuing vestibular therapy. Vestibular therapy an effective treatment, and having a specialist take you through a course of treatment will allow you to recover more quickly. The patient’s physician typically makes the initial referral to vestibular therapy after a thorough medical evaluation of concussion.

4. If so, what vestibular rehabilitation techniques help to reduce symptoms and improve function?

The technique used in vestibular therapy depends on the nature and severity of the symptoms, as well as the underlying cause. When someone sustains a concussion, symptoms of vertigo may occur with positional changes. This diagnosis is called Benign Paroxysmal Positional Vertigo (BPPV), which commonly occurs after head injury. The treatment for BPPV is very specific and should be performed by a trained clinician. If BPPV is not present, then balance exercises and vision retraining exercises that address how the head and eyes move together are very effective in reducing dizziness and imbalance. Exercises selected are highly specialized and very specific to the individual’s symptoms and daily activity demands, and should only be performed by a clinician that has training in this type of therapy.

5. Are there specific exercises or strategies most helpful for improving symptoms after concussion?

See above answer 4.

6. Do you recommend vestibular rehabilitation for all patients post-concussion? Are there patients with certain symptoms who benefit most?

Vestibular therapy is not indicated for every patient who sustains a concussion.  Some people will be diagnosed with a concussion and will not have any symptoms related to dizziness, imbalance or vertigo. These patients do not need to participate in vestibular therapy.  On the other hand, any person who is experiencing dizziness, vertigo, and/or imbalance after sustaining a concussion would likely benefit from participating in vestibular therapy, especially if the symptoms persist for more than a few days. 

7. I’ve had quite a bit of neck pain and stiffness after a car accident. Could this be the cause of my dizziness?

Cervicogenic dizziness can occur with a whiplash injury and is often diagnosed with concussion. Cervicogenic dizziness is defined as the presence of dizziness, imbalance or unsteadiness related to movements or position of the cervical spine or related to a stiff or painful neck. The treatment for cervicogenic dizziness is therapy for the neck to help decrease the discomfort and stiffness. Reducing stiffness and muscle imbalance in the neck can help to decrease the sensation of dizziness.

8. Are there any screening measures or tests available that you’d find helpful to have prior to seeing a patient referred for VRT? 

Prior to starting VRT, a patient should be evaluated by a physician with specialized knowledge about concussion and brain injury. A concussion can cause a myriad of symptoms in addition to dizziness/imbalance, so a thorough and complete assessment of post-concussion symptoms is necessary to determine the correct course of treatment for each individual. Depending on the severity of the injury and the symptoms, an audiology evaluation may be helpful to more thoroughly assess inner ear function.  The physician overseeing the case usually determines which clinical tests need to be performed prior to initiating vestibular therapy.

9. What would you want the general public to know about concussion rehabilitation? 

Concussion rehabilitation is most effective and efficient when the patient receives a multidisciplinary evaluation and individualized approach to care. Concussion is a complex injury which should not be addressed using a “cookie cutter” approach to treatment and focusing on treatment of only one aspect of concussion may lead to a longer recovery.  

10. What is your overall key take home message for providers working with patients with suspected post-concussion dizziness? 

I would highly recommend that the provider working with post-concussion dizziness complete specialized training that addresses the nature of concussion/brain injury and reviews appropriate treatment protocols. I cannot stress enough the importance of having a multidisciplinary team of clinicians overseeing the treatment, management and rehabilitation of patients to ensure the patient is receiving the best care for his or her injury.   

 

Shelly Massingale is the senior director of Banner Concussion Services in Arizona and Colorado. She is a physical therapist and has been a specialist in vestibular and balance therapy for the past 22 years. Shelly has focused her treatment and research primarily in mild traumatic brain injury since 2013 and has lectured nationally and internationally on evaluation and treatment of vestibular and balance deficits related to mild traumatic brain injury.