Otoneurology -- Exciting stuff

Timothy C. Hain, MD and Marcello Cherchi, M.D, Ph.D. of Chicago Dizziness and Hearing

Page last modified: April 12, 2021

New chapter published on vestibular testing.

We just published a new chapter on Vestibular testing, in the American Academy of Neurology's "Continuum". (Hain and Cherchi, 2021). This work underwent a strong peer review process and documents the huge progress that the field has made recently in this area. In the recent past, we had strong measures for only 1/5 of the sensors of the inner ear (i.e. the horizontal semicircular canal). Now we can check all 5 with a combination of the VHIT test, and VEMP tests. This has greatly expanded the territory where we can make specific diagnoses.

Commentary on new treatment suggested for Meniere's.

men_new -- Proof that this new treatment (SPI-1005) works is presently a bit scanty. Still, hope springs eternal ... See the review.

New treatment for autoimmune inner ear disease

Recent advances in autoimmune inner ear disease: (11/7/2020)

Covid-19 related pages. We have attempted to comment on dizziness and hearing in Covid cases.

Our Meniere's page was ranked #1 for reliability on the web (3/2/2020)

Our Meniere's page was ranked as the most reliable web page on Meniere's, by an article in an Otolaryngology journal evaluating 50 web sites on Meniere's disease (Bojrab et al, 2020). Our score for reliability was 2.96, compared to (for example), Mayo clinic's page which scored 2.63 (which was google ranked #1). The maximum score is 3. We suspect if other pages on our site were ranked similarly, they would also score at the top for reliability because of our practice of supplying evidence for almost all factual statements, and separating opinion from evidence. We have recently seen pages from major institutions making rather outrageous claims -- we think because the pages are being edited by persons who are good at web design, but perhaps not experts in dizziness. Some pages from academic insitutions even make explicit disclaimers that they are not responsible for the content on their site.

Ranking of pages by Google is based more on suitability for serving advertisements than content. Most pages must be "mobile ready", meaning that you should be able to look up -- lets say -- Meniere's disease, on your cellphone. . So we are basically comparing content with the reliability score, with appearance (which is a huge portion of the Google score), with appearance winning over useful information.

The Chicago Dizziness and Hearing Database.

Chicago Dizziness and Hearing has a gigantic clinical database containing about 30,000 patient records going back to 1990, mainly concerning conditions including dizziness. We recently have developed tools to explore this database, and we are now beginning to update pages on this site with the aggregate results. We often have about 10 times the patients with particular diagnoses reported by others in the literature.

Newer academic output:

Migraine

A new treatment for chronic migraine has hit the "streets". Four of these drugs have now been approved since Early 2021. They are generally "anti-CGRP antibodies" (Giamberardino et al, 2016). There are also two new "pant" drugs, also working on CGRP, marketed for acute treatment. The CGRP antibody drugs are generally used when all else has failed. We do not find them useful for vertigo. Getting these drugs covered by insurance is difficult.

Visual Vertigo -- updated 3/2/2020

Visual vertigo is a condition where patients are intolerant of situations where there are large amounts of visual stimulation -- examples include walking through the aisles of a grocery store, difficulties with viewing scrolling computer screens, and driving problems where the speed gets above a certain threshold (often superhighway). It is sometimes diagnosed as a migraine variant (e.g. vestibular migraine), as a psychiatric condition (e.g. PPPD), as an ocular disturbance (e.g. in patients with 3rd nerve palsies or otolithic problems), and as a reorganization to loss of vestibular sensation (e.g. visual dependence). Generally speaking, the overlap is with other symptom inventories invented by various committees.

Some progress has been made in treating this condition by the optometry profession, through manipulation of eye-wear and visual exercises. We have recruited an OD to treat this condition, Dr. Marsha Sorenson. This is going well.

We are also expanding our visual vertigo treatment to include a specific regimen for PPPD (persistant postural perceptive dizziness). The core methodology will be as suggested -- an SNRI/SSRI and habituation for visual symptoms.

Mal de debarquement syndrome -- treatment with habituation.

Dai et al (2014) reported successful treatment with a variant of motion sickness, Mal de Debarquement, with a 5 day adaptation protocol. For a few years we treated patients with our own version of this protocol, but we stopped due to the logistical difficulties. We are hoping right now to make some progress with a cheaper home-based VR protocol. There is no hard evidence though that proves it works.

VHIT test

Chicago Dizziness and Hearing has the "VHIT" test machine, which is a device that quantifies the results of "head impulses". This is a new technology to assess vestibular function. It is very good in detecting unilateral vestibular loss, such as due to tumors or vestibular neuritis. It is also modestly useful in assessing vestibular compensation - -persons who are uncompensated have "overt" saccades, and those who are compensated have "covert saccades".

We also use the VHIT to follow patients with bilateral vestibular impairment, to decide whether or not they are getting worse. It is far less stimulating that the rotatory chair, and we sometimes use it in place of VENG/R-chair in motion sensitive persons. Again it is a little tricky as people can improve on the VHIT (due to compensation) but remain unchanged on the rotatory chair (when one considers the entire vestibular response). We have also found VHIT somewhat helpful in occasional situations where a "tie breaker" is needed between ENG and rotatory chair.

References to recent output.