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Vertigo

Vertigo

JAAA Latest Fast Track Articles—October 7, 2019

As the JAAA editors along with our editorial team, we are proud to announce new Fast Track content for JAAA, as of October 7, 2019

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The Audiologist’s Obligation to the Vertiginous Patient

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

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".

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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Feature 5: Story image

Essential Oils for Hearing Loss, Tinnitus, and Vertigo

Plant oils have been used medicinally for over 2,500 years. The first references to the use of plant oils can be traced to Chinese medicine, also known as Traditional Chinese Medicine.

Various parts of plants were consumed in either the raw state or dried, boiled, or steamed (to extract the oil). The end product was then consumed, inserted into any one of the natural openings of the body, massaged into the skin, or inhaled in vapor form. 

Topic(s): Tinnitus, Vertigo

Author(s): 

Publication Issue: Audiology Today July/August 2019

Feature 4: Story image

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

Preamble

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

Detecting Hearing Loss, Vertigo Via Blood Tests

On the one hand, the ability to detect inner-ear proteins as biomarkers of hearing loss and vestibular dysfunction from blood samples is very promising, but on the other, how hard is it to get the more primary care physicians to refer for a hearing test?

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Vaping and Hearing Loss

Opinion Editorial by David Fabry, PhD

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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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Meclizine: Update Issues and Answers

Desmond (2015) reports that Meclizine (aka Antivert, Nonine, and Dramamine II) is an antihistamine with antiemetic and anti-cholinergic properties (i.e., anticholinergics tend to block the transmission of acetylcholine in the PNS and CNS). MedicineNet.com reports that “Meclizine is an antihistamine with antiemetic and antispasmodic activity. It suppresses the nervous system by blocking the action of the neurotransmitter acetylcholine.

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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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