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.
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).
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.”
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
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.
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).
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.
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).
Cochlear Implants and Pediatric Post-Op Pain and Dizziness
Birman, Gibson, and Elliott (2015) evaluated post-operative surgical pain in children (ages 16 years and younger), following cochlear implant surgery via assessment of analgesia use. Between August 2010 and November 2012, 98 children were implanted, 61 were reported. Of the 61 children who were reported, 19 children required no pain relief and 42 children used paracetamol (aka acetaminophen in the United States) Additionally, 1 child required oxycodeine for 1 day (following bilateral implant surgery), and codeine phosphate was used by 1 child for 3 days.