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CSI AUDIOLOGY | When Is Ménière’s Disease Not Ménière’s Disease?

Dizziness is a common complaint, with approximately 35 percent of adults reporting dizziness, with the prevalence increasing dramatically with age (Agrawal, 2009). As the profession of audiology has evolved, so has our understanding of the various disorders that cause imbalance and dizziness. This article will walk you through the case of Sunny Susan (patient’s name changed to protect identity), a woman who I first saw as a balance patient after she had spent over 22 years struggling with recurrent dizziness and progressive hearing loss. 

Topic(s): Dizziness, Balance/Vestibular, Meniere’s Disease (MD), conductive-mixed hearing loss, Hearing Loss, Tinnitus, Patient care


Publication Issue: Audiology Today March/April 2018

Feature 4: Story image

Charles Wells & Erasmus Darwin: The Dueling ‘Vertiginous Philosophers’


The following historical summary could not have been possible without two literary works from Nicholas Wade and Benjamin Tatler: Destined for Distinguished Oblivion: The Scientific Writings of William Charles Wells (Wade, 2003) and The Moving Tablet of the Eye: The Origins of Modern Eye Movement Research (Wade and Tatler, 2005). 

Topic(s): Dizziness, Vertigo, vertiginous syndromes

The Cuban Medical Crisis

From late 2016 through August 2017, U.S. government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to “auditory and sensory phenomena.”  The report of a “sonic attack” was pervasive in the media, despite such a weapon being physically unlikely.  A recent communication published in the Journal of the American Medical Association (JAMA) provides an overview of findings from 21 individuals exposed to the “auditory and sensory phenomena” including tests of cognitive function, mood, balance, hearing, and vision.

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Sports-Related Concussions and Vestibular Symptoms

The annual estimate for sports-related concussions in the United States is between 1.6 and 3.8 million cases. Concussions produce a variety of symptoms with a headache as the top complaint. Other common complaints include auditory-vestibular symptoms, such as dizziness, tinnitus, and sound sensitivity.  Recently, Chorney et al. (2017) examined rates of audiovestibular symptoms following sports-related concussions among college athletes. Data were acquired from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS). 

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A Study Regarding Temporomandibular Disorders (TMD) Has Implications for Audiologists

Sampaio and colleagues in a recently-published article evaluated the prevalence of and relationship between several factors on temporomandibular disorders (TMD). These authors define TMD “as a cluster of disorders characterized by pain in the preauricular area, masticatory muscles and temporomandibular joint (TMJ), limitation or deviations in the mandibular range of motion, and clicking of the TMJ during the mandibular function.”

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Novitas Revises Medicare LCD for Vestibular and Audiologic Function Studies (L35007): Adds ICD-10 Codes for Conductive Hearing Loss and Dizziness and Giddiness (R42)

In late 2015, the Academy received reports from audiologists reporting denials for pertinent and appropriate ICD-10 codes that supported medical necessity for the audiology procedure codes being billed.  Upon further research, the Academy discovered that the

Dizziness, Confusion, Caffeine, and Salt

Beck (2015) reports that no two people experience dizziness the exact same way. What one patient describes as vertigo, another may describe as light-headed, woozy, dizzy, and more. Similar to tinnitus, headaches and lower back pain, one cannot disprove these sensations. However, it’s not just the variation in which words the patient uses, but the variation in the words the clinician uses, may also add to the confusion.

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Rethinking Semicircular Canal Dehiscence

Although posterior and superior canal dehiscence has been associated with vertigo, and/or dizziness, and/or low-frequency conductive hearing loss, often these associations/observations have been made after a symptomatic patient presents and high resolution CT scans are executed. Indeed, atypical CT findings are sometimes reported and consequently, the signs and symptoms which brought the patient in are then attributed to the atypical CT findings (for more information, see Chi et al, 2009; and Rosowski, 2012).

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Aging and Dizziness

Zalewski (2015) reports $10-$20 billion is spent annually secondary to falls and fall-related injuries. Indeed, falls and fall-related injuries are the sixth leading cause of death in the elderly and 20 percent of these events lead to death. The National Safety Council reports falls in people ages 75 years and older are “the number one cause of injury-related death.” Zalewski notes that 90 percent of people aged 80 years and older are likely to present with balance impairment which increases their risk for falls. 

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Falls, Dizziness, Diagnosis, and Medications

Migraine, Meniere’s Disease (MD), and vestibular migraine (VM) likely share a common pathogenesis. Unfortunately,  there is no “gold-standard” lab test to identify the “correct” diagnosis. Further, the audiologist, otolaryngologist, or neurologist (or other) must interpret the case history, physical findings, and test results to establish the differential diagnosis. Unfortunately, overlapping terms may be used to indicate the same (or highly similar) phenomena (Beck et al, 2013).

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