Dizzy Discourse: Updates in Vestibular Care – Cleveland Clinic

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Improvements, a Cleveland Clinic podcast for medical professionals exploring the most recent improvements, discoveries, and surgical advances in otolaryngology – head and neck surgical procedure.

Thanks for becoming a member of us for one more episode of Head and Neck Improvements. I am your host, Paul Bryson, Director of the Cleveland Clinic Voice Middle. You possibly can comply with me on X, previously Twitter, @PaulCBryson, and you will get the most recent updates from Cleveland Clinic Otolaryngology-Head and Neck Surgical procedure by following @CleClinicHNI on X. That is @CleClinicHNI. You can too discover us on LinkedIn at Cleveland Clinic Otolaryngology – Head and Neck Surgical procedure, and Instagram at Cleveland Clinic Otolaryngology.

As we speak I am joined by a returning visitor, Dr. Julie Honaker, Part Head of Audiology, in addition to a brand new visitor, Dr. Evalena Behr, an audiologist in our Vestibular and Balanced Issues Program. Dr.’s Honaker and Behr, welcome to Head and Neck Improvements.

Julie Honaker: Thanks a lot for having us.

Paul Bryson: Properly, I encourage everybody to return and hearken to our first podcast with Dr. Honaker, it is an episode on vestibular dysfunction administration. And for our new listeners, let’s begin by having you share some background on yourselves, the place you are from, the place you each skilled, the way you got here to Cleveland Clinic.

Julie Honaker: Properly, once more, thanks for having us. It is so good to come back again and be a part of you right here on the podcast. I am Dr. Julie Honaker and I’m Ohio born and raised in southwest Ohio. I truly did my schooling on the Ohio State College and the College of Cincinnati the place I went on for my grasp’s in audiology, after which I used to be proper on the cusp of the doctorate in audiology and I made a decision to go on and pursue my PhD. I simply ended up having extra questions than I discovered solutions for in my graduate program, and determined I wished to have a scientific analysis diploma. After my coaching in Cincinnati, I went on to do a postdoctoral fellowship on the Mayo Clinic the place I labored with Dr. Neil Shepherd who was an knowledgeable within the area of vestibular issues. I spent two years there after which I moved all the way in which to Nebraska the place I used to be an assistant professor after which tenured to affiliate professor. And round I need to say January of 2016, I acquired an e-mail from Dr. Craig Newman, who’s the previous part head of audiology at Cleveland Clinic, asking if I had any curiosity in coming again to Ohio to start out a vestibular and stability dysfunction program and it gave the impression to be the fitting time for my household. So we made the transfer and I have been right here ever since.

Paul Bryson: Properly, we’re glad that you just did and we’re glad you are right here, and it has been an thrilling time to see a lot progress in your group.

Julie Honaker: Yeah, we’re. It’s totally thrilling and not too long ago employed just some years in the past, employed Evalena Behr, so I will let her inform you a bit bit about her story.

Evalena Behr: Good. So I’m from south Florida. I went to grad college on the Nova Southeastern College, so I went to the Physician of Audiology program in contrast to a PhD route. So our final 12 months is only a pure scientific externship 12 months and you’ll actually go wherever you appreciated. After I was taking a look at completely different packages, I truly did a presentation at school on fall danger and seen I used to be citing quite a lot of Julie Honaker’s work. So once I interviewed on the Cleveland Clinic, I used to be interviewing with Dr. Honaker and it was simply somebody that I actually wished to work with, and that was actually one in every of my high causes for coming to the Cleveland Clinic in Ohio. Individuals all the time ask, why did you allow South Florida to come back to Ohio? And from there I completed my externship and I used to be fortunate sufficient to get a vestibular fellowship with Dr. Honaker. And from there I completed that about nearly a 12 months in the past. So I have been on board as a supplier for a couple of 12 months on the Cleveland Clinic.

Paul Bryson: Properly, congratulations on ending your program and it is nice to have you ever as a part of the workers right here this final 12 months.

Evalena Behr: Enjoyable to be right here.

Julie Honaker: I am fortunate to have her.

Paul Bryson: Properly, we’ll dive in right here a bit bit. Our listener is, it is perhaps sufferers, it is perhaps different healthcare suppliers, however yeah, I will dive in with some scientific questions and we’ll speak a bit bit in regards to the heart and issues like that. So when sufferers current with signs like listening to loss or vertigo, what position does the vestibular check battery analysis play and the way’s it helped establish or information affected person therapy?

Evalena Behr: So what we all the time inform sufferers is that we act as little investigators for the referring supplier or the medical physician or superior apply supplier like an AP – nurse practitioner or PA. So we actually measure the operate of the vestibular system, not essentially the construction. And we’re taking a look at are the ears sending or the vestibular system sending equal and symmetrical info to the mind about actually the place the pinnacle and physique is in house. So one factor that we’re taking a look at with that’s we will help localize – the vertigo is coming from the fitting ear versus the left – and generally it is necessary for our referring suppliers to correlate that with listening to to assist discern the prognosis.

We are able to take a look at the place the affected person’s at of their therapeutic course of or what we name the compensation course of. A variety of our findings will help information therapy for our bodily therapists, which we could discuss later once we discuss a few of our analysis. After which generally for surgical candidacy, our outcomes will help decide if the affected person’s a cochlear implant candidacy or if it could be higher to implant the fitting versus the left ear. We are able to additionally pull out generally very high-quality particulars about if there’s any central versus peripheral vestibular involvement. So our testing will help our referring suppliers in some ways we imagine.

Paul Bryson: Yeah, I admire that rationalization. I will inform you as a no-otologist, generally vestibular points is usually a little intimidating and we actually want a bit little bit of steering. What are a few of the care paths that can be utilized to deal with vestibular issues by which therapy choices do you see mostly as a place to begin?

Julie Honaker: I feel the one factor simply sort of shed some gentle on vestibular issues. It actually comes right down to our position sort of as these investigators and attending to the basis reason for the affected person’s signs. So dizziness and stability and vertigo. These are debilitating signs that one could expertise, however they’re inner signs and it is usually very tough for sufferers to explain really what they’re experiencing and for suppliers to establish what to be the perpetrator as a result of there’s so many alternative methods, whether or not it is peripheral, neurologic, cardiovascular, blood strain associated, even medicine associated causes and pure ageing results that may very well be a supply for why any person can be experiencing these signs. So oftentimes we are saying the very best care path is for sufferers to first have a dialog with their major care or their household apply supplier relating to their signs. From there, relying on the signs, if there’s one thing that sounds prefer it’s extra triggered, there’s an ear associated co-occurrence the place they’re having maybe listening to associated issues, ringing within the ears, ache of their ears or discharge that may ship them extra our path inside the realm of ENT-audiology and the place our testing could come into play to assist decide what may very well be the trigger.

Typically if it is simply one thing that is extra place set off modifications for his or her signs, their signs are very transient they usually’re really one thing that is remoted the place they will actually inform you what’s bringing it on, it is solely lasting for a couple of seconds. Typically they will nonetheless see us as a primary care path or generally they will even be seen by bodily remedy as a path to rule out the commonest trigger for vertigo and dizziness, which is an issue known as benign paroxysmal positional vertigo or the place any person has tiny little dense gravitational crystals inside their ear buildings can change into dislodged and when this occurs, it could possibly convey on transient signs of vertigo. Typically if they’ve neurologic causes, it is a path to get them to neurology first. So it is oftentimes having sufferers simply open up with their household apply to find out what the signs are, what are related signs and triggers, and that may assist allude to what path is perhaps the very best route for administration first.

Paul Bryson: It feels like a very multidisciplinary method, and it feels like as is the case with us generally, generally we are the first level of entry and then you definately get to do the analysis and perhaps discover, hey, you is perhaps higher served by going and seeing this supplier or that supplier. Have you ever had quantity of buy-in from a multidisciplinary method? Are you able to discuss the way you coordinate care in a multidisciplinary style or how you’re coordinated as a part of care in a multidisciplinary style?

Evalena Behr: In order that’s an incredible query. We seen the identical factor the place it’s a advanced staff and there is usually many causes to dizziness and vertigo and being on the Cleveland Clinic, generally sufferers come from throughout and our vestibular check battery appointment is often two hours. So if somebody comes from out of state, it is actually arduous for them to do an add-on VTB. So what Caitlin Sukalac, one in every of our otology Pas, and I seen is that this subject, and we attempt to repair it by making a Dizzy Clinic. So it is largely for out of state sufferers, however generally they will even be native or simply two hours down the street, an hour down the street. However actually it is sort of the one cease store. They see her, they get a vestibular check battery they usually get a listening to check all in a two or three hour span. Then she and I sit and we speak in regards to the outcomes and we discuss it from her medical lens and my lens, the audiologic lens the place I am trying on the operate of the system. And I feel we have had actually good outcomes with that thus far. Sufferers appear to essentially take pleasure in it. They will get the whole lot carried out directly they usually know they’ve two suppliers coordinating and speaking about their signs and their care.

Paul Bryson: I imply, that is unbelievable. I imply, you are proper. Typically persons are simply seeking to attempt to discover the fitting individual. So to have the ability to present that affected person expertise is admittedly commendable. So congratulations on with the ability to roll out that clinic. I additionally wished to speak a bit bit, I heard you point out earlier Dr. Behr, simply generally the affect of stability within the context of surgical candidacy, perhaps with cochlear implants, perhaps with different issues. Only in the near past we spoke to Dr. Bassim and to Dr. Sydlowski, two of your different colleagues on cochlear implantation and expanded candidacy. Are you able to speak a bit bit about how stability and cochlear implant candidacy play collectively? I’m not as aware of that, however it actually is sensible.

Julie Honaker: With respect to anybody who could also be contemplating a cochlear implant with vital listening to loss, and I do know that they are increasing the candidacy to incorporate people with the much less profound listening to loss because it was a few years age, however anytime there’s somebody with a priority of listening to loss, simply due to the character of how shut in proximity the listening to organs are to the vestibular organs, we all the time need to surprise if they might even have a stability downside. And for therapy for somebody with listening to loss, the surgeons are inserting an electrode ray into the ear, which is in such shut proximity to the stability organs that we all the time need to surprise if we’re serving to one a part of the system that may very well be inflicting any injury to the opposite, and what’s the start line for any person as a result of we need to make it possible for we’re treating the entire individual. And since there’s quite a lot of analysis that is been popping out over the previous decade simply taking a look at affiliation of fall danger and listening to loss, we need to make it possible for we are able to greatest handle these sufferers in order that they’ve constructive outcomes for his or her listening to in addition to their stability each pre and post-surgery.

So we’re together with now as a part of a analysis examine, we’re trying on the affect of cochlear implantation on stability, which is fairly well-known within the literature, however we have now truly carried out an intensive literature overview, checked out what are some triggers that may warrant people to have stability testing pre in addition to publish. And we’re checking the outcomes for these people in order that we are able to get the very best administration in place for them.

Paul Bryson: That is nice. Thanks for that. What else is on the horizon so far as analysis that you just each are enthusiastic about you? You talked about falls, we talked about cochlear implants. What else are you enthusiastic about?

Evalena Behr: So like I discussed earlier, a few of our testing will help information bodily remedy and their therapy, and there is a number of routes like Dr. Honaker talked about. They will go to PT first or they will come see us first. And one in every of our analysis questions, and we collected the information, we did a pleasant presentation at a nationwide convention per week or two in the past about it, however we’re trying on the variety of classes once they see us first, as a result of we have now that details about the therapeutic course of versus once they see PT first. So much like when you will have knee ache and your major care physician says, go to PT first after which we’ll come again and perhaps get an imaging examine or two or do extra diagnostic testing. So we wished to have a look at what triggers once they go to PT first ought to warrant an entire vestibular analysis as a result of generally, not in each case, however they will do a number of classes the place there’s quite a lot of alternative and economical price to going to PT and never having a transparent prognosis versus coming to us first receiving that details about the operate, the positioning of lesion, the standing of compensation, after which going to PT afterwards.

And we have now some fairly good outcomes, and I feel we’ll have some good info popping out fairly quickly about it, however I feel we’ll assist information interdisciplinary apply basically in order that sufferers can nonetheless be seen by bodily remedy, however then additionally bodily therapists could be armed with the data when simply refer them to us to assist information their therapy plan.

Paul Bryson: Yeah, congratulations on that venture. Thanks. That is thrilling.

Dr. Honaker, you latterly had a paper revealed on interprofessional schooling interventions to enhance the supply of secure and efficient affected person care with respect to vestibular issues. Are you able to share some background in addition to your findings?

Julie Honaker: Certain. Properly, thanks a lot for asking about this. I’ve to confess although the paper wasn’t with respect to vestibular issues, however simply sufferers basically. I had the pleasure of serving on the American Speech Language Listening to Affiliation board of administrators, and a part of my position was Vice President for Educational Affairs and Audiology, and I served with different disciplines as a part of this interprofessional schooling collaboration the place we performed a scoping overview over a five-year interval from 2015 to 2020 the place we had been actually taking a look at “does interprofessional schooling make a distinction for our affected person so far as their outcomes?”

So we did this in depth scoping overview and we whittled it right down to about 94 articles, and we actually had been making an attempt to key some particular highlights. Does interprofessional schooling, that means multiple self-discipline, both it is suppliers or college students working collectively to deal with coaching, does that enhance affected person outcomes? And it truly did, they usually had well being measures that we discovered the place there was decreased size of keep within the hospital, decreased medical areas, or excuse me, improved affected person satisfaction, improved supplier satisfaction for what they’re doing and extra, much less burnout due to this. And actually that working collectively, the adage of two heads are higher than one. It does work. And that is actually what we attempt to do even with our analysis questions. We’re making an attempt to have an interdisciplinary lens with this to see how we are able to enhance the administration and the care path for our sufferers with their debilitating signs.

Paul Bryson: That is nice. I do know quite a bit, there’s quite a lot of consideration appropriately so to adults with falls and different vestibular situations that you just talked about earlier within the podcast, however I perceive vestibular care could be prolonged and may contain our pediatric sufferers too. What kind of labor can we anticipate from the group on the subject of our pediatric sufferers?

Evalena Behr: Yeah, that is an incredible query. Dr. Honaker and I simply added extra a pediatric-focused slots on our template. So we’re seeing extra pediatric sufferers, and there is quite a lot of new information out displaying that there could be longstanding impacts when sufferers have pediatric vestibular dysfunction as a baby, once they have bilateral loss. So once they have dysfunction of each ears, their stability can sort of plateau at 4 years of age. And that is labored from Dr. Cushing’s lab at SickKids in Toronto. And if we take into consideration that, we might by no means let a baby’s language plateau at 4 years. So I feel that basically exhibits the significance of pediatric vestibular testing, and I feel even so this clinic particularly as a result of younger youngsters can not all the time articulate their signs effectively, so goal info is usually useful in diagnosing and once more, serving to with the administration and pediatric vestibular issues.

Paul Bryson: That is very thrilling. That is nice to listen to. And I feel your instance, we hear a lot about new child listening to screening and detecting listening to loss at a younger age. It appears simply the identical that you’d hope to establish vestibular alternatives on the youngest age potential as motor abilities develop and whatnot.

Evalena Behr: You bought it. Precisely.

Paul Bryson: Properly, I admire your time, each of your time being right here on the podcast as we wrap up at present, any remaining take dwelling messages for our listeners?

Julie Honaker: I feel simply once more, for those who’re experiencing, for those who’re a affected person who’s experiencing or have a cherished one who’s experiencing dizziness, vertigo, or imbalance, have a dialog with your loved ones apply or inner drugs doctor or supplier. From there, you is perhaps coming our manner, and we’ll do our greatest to work as detectives to attempt to discern what may very well be the perpetrator to your signs and get you to that proper supplier for administration.

Paul Bryson: Properly, when vertigo, dizziness and stability issues have you ever or your sufferers feeling off stability, rely on the specialists right here, Dr. Behr and Dr. Honaker at Cleveland Clinic to assist. For extra info on vestibular therapy at Cleveland Clinic, go to ClevelandClinic.org/Vertigo. That is ClevelandClinic.org/Vertigo. And to attach immediately with a specialist or to submit a referral, name 216.444.8500. That is 216.444.8500. Lastly, make sure you comply with our audiologists on Instagram and Fb at Cleveland Clinic Listening to and Stability.

Dr.’s Behr and Honaker, thanks for becoming a member of Head and Neck Improvements.

Evalena Behr and Julie Honaker: Thanks. Thanks for having us. Take care.

Paul Bryson: Thanks for listening to Head and Neck Improvements. You’ll find further podcast episodes on our web site clevelandclinic.org/podcasts. Or you may subscribe to the podcast on iTunes, Google Play, Spotify, BuzzSprout, or wherever you hearken to podcasts. Do not forget, you may entry realtime updates from Cleveland Clinic specialists in otolaryngology – head and neck surgical procedure on our Seek the advice of QD web site at consultqd.clevelandclinic.org/headandneck. Thanks for listening and be a part of us once more subsequent time.

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