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Successful Management of Balance and Vestibular Disorders with A Team Approach

 

Feeling a Little Off Balance?

According to the Vestibular Disorders Associations article on The Human Balance System, “Balance is the ability to maintain the body’s center of mass over its base of support.”  The human balance system involves a complex set of sensorimotor-control systems. Its interlacing feedback mechanisms can be altered through damage to one or more components either by injury, disease, certain drugs, or the aging process. the components involved in maintaining balance depends on the integration and coordination of information received by the brain from 3 peripheral sources:

  • Eyes – Vision cues the brain to identify how a person is oriented relative to other objects
  • Muscles and Joints – Motor activity sends cues indicating the body’s movement or sway relative to the surface, and quality of that surface (hard, soft, slippery,etc)
  • The Vestibular System – Sensory information about motion, equilibrium, and spatial orientation is provided by the vestibular apparatus, which in each ear includes the utricle, saccule, and three semicircular canals.

The American Hearing Research Foundation (see link below) reportsThe word “vestibular” refers to the inner-ear balance system. To achieve good physical balance we rely on our brain, eyes, inner-ear, and muscular-skeletal system to work in harmony. Balance is commonly taken for granted until it is impaired. A person can become disoriented if the sensory input received from his or her eyes, muscles and joints, or vestibular organs conflicts with one another. It has been estimated that 40% of the population, at some point in their lifetime, will experience some form of balance or vestibular disorder.

The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. If the system is damaged by disease, aging, or injury, vestibular disorders can result, and are often associated with one or more of these symptoms, among others:

Dizziness affects our quality of life and sense of independence, and it doubles the risk of falling. Falls are the number one cause of trauma, hospital admissions, and fractures in older adults, with more than 1.6 million reporting to hospital emergency departments each year (National Institute on Aging, 2013).  Research shows It is not uncommon for patients with dizziness to see up to four physicians and to have visited the hospital emergency department at least once for their symptoms. Some patients’ histories go back many years without a clear  diagnosis.

Diagnosing and Treatment Through a Team Approach

American Speech-Language-Hearing Association (ASHA) sites in their article “Diagnosis and Management of Balance/Vestibular Disorder: A Team-Based Approach” (see link below) “The most effective way to manage dizziness in patients is with a multidisciplinary team or an IPE/IPP-based approach. According to the WHO the use of a wrap around approach through multidisciplinary team members shows to be critical to achieving the three goals of (a) improve the patient’s experience (quality and satisfaction), (b) improve health, and (c) reduce the per capita cost of health care. 

The most effective way to manage dizziness in patients is with a multidisciplinary team or an IPE/IPP-based approach. Balance/vestibular disorders can be complex and difficult to diagnose, as they can have multiple causes that often cannot be isolated to a single source. Because of the brain’s adaptive responses, the resulting impairments from a specific cause can vary considerably from one patient to the next. In addition, these multiple causes may arise from different sensory systems. These multisystem problems may require expertise from more than one medical specialist for appropriate management. Having a working relationship with a group of providers is most effective in the care of this population. However, it is not necessary for IPE/IPP team members to be part of the same group or site. Often, the patient who is experiencing dizziness will initially seek consultation with various health professionals, including those in primary care, otolaryngology, neurology, or emergency medicine. Point of entry may lead to consultation with additional health care team members specializing in cardiology, audiology, and physical therapy.

References:

Vestibular Disorders Association VEDA/top-ten-steps-facts-you-should-know/

American Speech-Language-Hearing Association (ASHA)/Articles/Diagnosis-and-Management-of-Balance-Vestibular-Disorder/?utm_source=asha&utm_medium=enewsletter&utm_campaign=accessaud091316

Vestibular Disorders Association/understanding-vestibular-disorder/human-balance-system

 

Autoimmune Inner Ear Disease (AIED)

What is Autoimmune Inner Ear Disease?

Autoimmune Inner Ear DiseaseAccording to www.american-hearing.org, Autoimmune Inner Ear Disease is defined as a syndrome of progressive hearing loss and/or dizziness that is caused by antibodies or immune cells which are attacking the inner ear. In most cases, there is a reduction of hearing accompanied by tinnitus (ringing, hissing, roaring) which occurs over a few months. Variants are bilateral attacks of hearing loss and tinnitus that resemble Meniere’s disease, and attacks of dizziness accompanied by abnormal blood tests for antibodies. About 50% of patients with AIED have symptoms related to balance (dizziness or unsteadiness).

How Can The Immune System Affect Your Ears?

The immune system is complex and there are several ways that it can damage the inner ear. Both allergy and traditional autoimmune diseases can cause or be associated with AIED.

AIED Course

AIED will manifest as a rapidly progressing, sensorineural hearing loss that is most commonly bilateral. Typically, it begins unilaterally and ultimately affects the other ear, and it can occur suddenly. Word recognition is usually disproportionately poor. Vestibular symptoms can have a fluctuating course during the active phase of disease. Additionally, tinnitus, as a ringing, roaring, or hissing noise, may be present. Diagnosis can be difficult because AIED can mimic other ear disorders. In any patient with presumed AIED, it is essential to rule out other causes of progressive sensorineural hearing loss, such as acoustic neuroma, neurosyphilis, and Meniere’s, as well as other metabolic conditions.

Testing For AIED

Because of the difficulty in the differential diagnosis of AIED, many have proposed the use of lab tests to assist in the medical diagnosis, such as:

Autoimmune Inner Ear Disease

  • CBC (complete blood count) to check for leukemia or other hemolytic disorders;
  • FTA/ABS blood screen for syphilis;
  • MRI, with contrast, of brain and cerebellopontine angle to check for MS, vascular lesions, and space-occupying lesions;
  • Lymphocyte blast transformation to check for inner ear antigen, which may underlie AIED (the efficacy of this test is controversial);
  • Rheumatoid factor and anti-nuclear antibody, as mentioned above;
  • Lipid panel to check for dylipemias
  • Various steroid trials

Autoimmune Inner Ear Disease Treatment

Steroids: There are several protocols for treatment of AIED. In cases with a classic rapidly progressive bilateral hearing impairment, a trial of steroids (prednisone or dexamethasone) for four weeks may be tried. This treatment is inexpensive, but if effective, it is difficult to maintain because of steroid side effects.

Plasmapheresis: It has also been reported recently that plasmapheresis may be beneficial in AIED (Bianchin et al 2010). Plasmapheresis is expensive, must be done periodically (usually monthly), and intrinsically it is only suitable for disorders mediated by antibodies.

Autoimmune Inner Ear DiseaseCochlear Implant: Cochlear implantation can be successful in AIED, and it may be indicated when there is acquired bilateral deafness.

Cell and Gene Therapy: Cell therapy involves transplantation of individual stem cells capable of developing into inner ear cells in the ear canal. Gene therapy is the introduction of new genes into native cells, allowing the cells to produce new proteins that improve their ability to function.

Sources:

American Hearing Research Foundation

American Speech-Language-Hearing Association

lyric hearing aids

Lyric Hearing Aids

What are Lyric Hearing Aids?

They are the first extended wear hearing device that is 100% invisible. They are comfortably placed in the ear canal by a Lyric  trained hearing professional and can be worn 24 hours a day, seven days a week, for up to 4 months at a time. No surgery or anesthesia is required.

Unlike many other hearing aids, Lyric Hearing is positioned completely inside the ear canal, so it uses your ear’s natural anatomy to funnel sound to your eardrum. This unique design and placement helps reduce background noise and feedback and provides exceptionally natural sound quality. Because it remains in the ear canal 24/7 for months at a time, you don’t need to worry about daily hassles like putting the device on or taking it off, or changing batteries, so you can forget about your hearing loss and spend time connecting with friends and loved ones.

What are the Benefits of Lyric Hearing Aids?

  • They are 100% invisible.
  • They produce clear, natural sound.
  • They provide effortless all-day hearing.
  • Lyric Hearing Aids can be worn for months at a time without taking them out.
  • The deep placement directs sound into the ear canal naturally for reduced background noise and exceptional sound quality.

How do They Work?

 Lyric Hearing is not appropriate for all patients. See a trained Lyric Hearing professional to determine if it is right for you.
lip reading

A Look into Lip Reading

What is Lip Reading?

Lip reading allows you to “listen” to a speaker by watching the speaker’s face to figure out their speech patterns, movements, gestures and expressions. Often called “a third ear,” lip reading goes beyond simply reading the lips of a speaker to decipher individual words. Some also refer to it as Speech Reading.

Learning to lip-read involves developing and practicing certain skills that can make the process much easier and more effective.

Skills Involved in Lip Reading

  • Watching the movement of the mouth, teeth and tongue
  • Reading facial expressions
  • Paying attention to body language and gestures

Facts About Lip Readinglip reading

  • Consonant shapes (p, f, sh, w) are:
    • Hard to hear
    • Easy to see
    • High-frequency sounds
  • Vowel shapes are:Easy to hear
    • Hard to see
    • Low-frequency sounds

Lip Reading Involves:

  • Hearing some of the sounds
  • Recognizing and interpreting facial expressions, body language and gesture.
  • ‘Putting two and two together’ and guessing words that you can neither lipread or hear by using the context and common sense to help you.

Did you know that sentences are easier to lipread than individual words and long words are easier to lipread than short words?

For more information on Lip reading, check out these resources:

Lipreading.org

HearingLink.org

cochlear implants

The Benefits of Cochlear Implants

What are the Benefits of Cochlear Implants?

What is a Cochlear Implant?

Cochlear implants are a means of surgical amplification for patients with severe-to-profound sensorineural hearing loss. There is an internal and external device as part of the implant. Appropriately-identified adults and children with severe to profound hearing loss can be implanted starting as early as 12 months of age.

Cochlear implants are used in the patient who cannot benefit from hearing aids. The cochlear implant is a device used to bypass the damaged organ of hearing and convert sound into electrical impulses that can directly stimulate the hearing nerve. The implant has of an external portion worn on the ear like a hearing aid or on the body. This device, called the sound processor, is comprised of a microphone, power compartmcochlear implantsent and external coil. The internal portion, which is typically made of ceramic or silicone, consists of an electrode array and must be surgically implanted. The surgical procedure involves the placement of an internal receiver beneath the skin behind the ear, and the electrode array, which is inserted into the organ of hearing, or the cochlea. The electrical signals are programmed by the audiologist to maximize speech perception and are controlled by the speech processor. The brain interprets these electrical impulses as sound.

To find out more about cochlear implants, please refer to our blog titled; Cochlear Implants.

The Benefits Include:

  • The majority of adults benefit immediately. Once the initial tuning sessions have been completed, they will continue to improve for about 3 months. After that, performance will continue to improve, but at a slower rate.
  • The ability to perceive loud, medium and soft sounds. The majority of people report that they can perceive different types of sounds, such as footsteps, slamming of doors, sounds of engines, ringing of the telephone, barking of dogs, whistling of the tea kettle, rustling of leaves, the sound of a light switch being switched on and off, and so on.
  • Understand speech without lip-reading. Even if this isn’t possible, the implant will help with lip-reading.
  • The ability to watch TV more easily. This will also improve if the user is able to see the speaker’s face. However, listening to the radio is often more difficult as there are no visual cues available.
  • Most are able to make phone calls.  Some good performers can make normal telephone calls and even understand an unfamiliar speaker. However, not all people who have implants are able to use the phone.

Want to know about Cochlear Implants? Check out the links below:

FDA.gov

BettterHearing.org

MayoClinic.org