Vestibular Disorders

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System.

Melanie Cole, Host: Welcome to Weekly Dose of Wellness. I'm Melanie Cole, and according to the American Speech-Language Hearing Association, approximately 40% of the population in the United States will experience some form of dizziness or balance difficulty over the course of their lifetime. My guest today is Mitchell Tsurudome. He's a physical therapist with Orange Coast's Vestibular Rehabilitation Program, and he's here to discuss the vestibular program offerings at Orange Coast Medical Center. Mitchell, I'm so glad to have you join us today. Tell us a little bit about vestibular disorders, and what are the most commonly diagnosed disorders that you see?

Mitchell Tsurudome, PT: The vestibular system are sensors that we have in our body. More specifically, these sensors are located deep in our ears and in our brain, and they're responsible for keeping our balance or our equilibrium. These sensors keep us on our feet when we're walking, standing or making turns. It also allows us to keep our vision focused on an intended target when we are walking, moving or even when we're driving. But sometimes these sensors go awry, so the vestibular system fails to function and that's when one can feel unsteady, dizzy, lightheaded or some have described as just feeling off. They will have a hard time walking straight or may trip, stumble, or fall often. There's a tendency of walking slower or they may even shuffle their feet. Oftentimes they may bump into things like doorways. Closing their eyes as in showering can be difficult as is walking across a dark or dimly lit room. There are also instances of vertigo. So vertigo is the sensation of spinning. Either you feel as if you're spinning or the room around you is spinning, something similar to being on a merry-go-round or carousel. That, of course, will make it hard to move and stay on our feet. And the more common instances vestibular disorders and actually there's many of them, but I wanted to highlight three common ones, so one of the more common disorder is vestibular hypo function that is in a case where our sensors that centers that provide our balance decline in sensitivity so they simply fail to work well unfortunately as we age our vestibular function can naturally become weaker. This actually can occur in as many as 50% of the geriatric population. Other cases can be an inner ear infection, and this is an important area of our vestibular system due to where these sensors are located. This condition is called neuritis or labyrinthitis. Even though it is in the inner aspects of the ear, your hearing may not be affected, but will often feel dizzy or experience vertigo, which leads me to the third disorder. The third disorder is actually a very common case of vertigo or spinning. This condition is called benign paroxysmal positional vertigo or BPPV. Some have referred to this as rocks in my head or crystals in my ear. Well, while this is not quite technically exact, BPPV can certainly cause a very unsettling spinning sensation. The interesting thing about BPPV is that it's usually short-lived, within a minute, and actually very treatable.

Melanie Cole, Host: That was a lot of good information, Mitchell. So first thing is when someone starts to get some of these symptoms that you've mentioned, rocks in their head, dizziness, nausea, difficulty walking, bumping into doors, any of those things, what do they do first? Who do they go see? Because right away you think, oh, I need to see a neurologist. So who do they go see and how do you detect whether it's BPH or BPV or whatever it is? How do you detect it, diagnose it?

Mitchell Tsurudome, PT: Your doctor will be able to determine if you have a vestibular disorder versus other factors, including reactions to medications, a stroke or history of a stroke or cardiac issues. In some cases, your doctor may refer you to an ear, nose and throat doctor, an ENT, or an audiologist who can perform various tests to diagnose your condition.

Melanie Cole, Host: So often people, and I'm an exercise physiologist, Mitchell, so I see that when people have these kinds of benign positional vertigo issues, that they don't want to exercise and then they, know, really have more of a sedentary lifestyle. So this pervasive fear that they might fall. What do you say when they tell you that and why is it important for them to try and stay active?

Mitchell Tsurudome, PT: It is. Yeah, that's so true. There is a fear of exacerbating their dizziness or vertigo and or there may be an inherent fear of falling, and in that case, they do become inactive and sedentary. This leads to a gradual decline in strength and conditioning, mobility and balance, and at that point, they may be at an even higher risk of falling. So this is a vicious downward cycle. Staying active is important towards maintaining their function, overall health, and independence. And thus, it is important to get checked out for these issues of BPPV, dizziness, vertigo, and so forth.

Melanie Cole, Host: So not all balance programs treat vestibular disorders as a whole. which is what makes the program at Orange Coast unique, Mitchell. So what type of specialty training should a therapist have who treats patients with vestibular disorders, as this is not that common to find someone as specialized as you?

Mitchell Tsurudome, PT: Yeah, a balanced program, while very important in itself, will not necessarily address the vestibular component that may involve patients. All physical therapists can actually treat balanced problems. We are balanced experts, but there are others that do have specialized training for vestibular rehabilitation. And we have physical therapists here, including myself, who are specifically trained for these cases. as well as your balance issues.

Melanie Cole, Host: It's so interesting. What an interesting profession that you're in. So tell the patients what they can expect during an initial evaluation appointment if they come in to you.

Mitchell Tsurudome, PT: So number one, we need to get a good medical history. So we need to evaluate if there are potentially other contributing factors to your condition, your dizziness. or difficulty with staying on your feet. Number two, we'll conduct a few tests. Some of these tests will require looking at your eyes to see abnormal or normal reactions to movements or positions. We need to determine the cause of the balance issue or dizziness. I have to admit that sometimes we need to cause the dizziness to actually treat the dizziness. Number three, if indicated, we will perform quick treatment techniques to help things get back into balance. And finally, exercise. There may be home exercises that are necessary to establish a progression towards recovery.

Melanie Cole, Host: So you mentioned something that patients might find a little bit unnerving, that you have to recreate the dizziness to be able to, you know, get them to adapt to it? Is that what you're trying to do is get that adaptation? What are you doing when you do that?

Mitchell Tsurudome, PT: Yeah, there is an adaptation aspect to establishing balance and dizziness, actually recovering from it. And we do have to actually cause a dizziness to actually see what the problem is. And from there, we can make the appropriate treatment. So yeah, we do sometimes have to cause the problem, but usually it's a very controlled manner and usually it's short-lived and we could actually help you immediately if that's the case.

Melanie Cole, Host: Great information. So on average, how long does someone stay in a vestibular therapy program?

Mitchell Tsurudome, PT: Yeah, I've had cases where just one session may help, but on average, we may need three to six sessions over the course of a couple weeks to a month. Most cases may be exercise-based, and so we could show you how you could do them at home on your own.

Melanie Cole, Host: Well, that's terrific that people can actually work on these things on their own and get really practiced at it so that they can help themselves if they have one of those episodes. What are some of the complications if somebody does not do anything about it? I was worried because my dad has BPPV and when he drives you go to turn your head and that's when you could experience one of those things. So driving for me was a fear with him. What about other people? What are some of those long-term effects that you are concerned with?

Mitchell Tsurudome, PT: Well, you know, fortunately, most cases will not be significantly affected due to a long history of a vestibular problem. I've had patients where they had the problem for years, and within just a few treatments, they were showing impressive improvements. But of course, it's best to seek treatments earlier than later, especially if they're at high risk or falls or they become or are becoming less active and sedentary due to their condition. But balance or history of falls, whether it is due to a vestibular problem or not, is much easier to address earlier than later.

Melanie Cole, Host: It certainly is. So as we wrap up, what's your best advice that you would like the listeners to take who think they may have a vestibular disorder and they're not quite sure where to turn or what to do?

Mitchell Tsurudome, PT: Interestingly, the good old internet actually can provide good information, but it may lead you astray as well. So you have to be careful. But I really like the website vestibular.org. I actually use them as a resource. It's very user friendly and provides information in layman terms. But the most important thing you can do is ask your doctor about your dizziness. You need to tell your doctor that you have a difficulty with walking, you're fearful of walking, you stumble or shuffle your feet, you bump into doorways or walls, you have episodes of vertigo, or simply if you fell recently, even though you may not be physically hurt, you need to tell your doctor. I've had patients who simply accepted their balance impairments and dizziness, not knowing that there may be treatments. I do think that it is very important that they ask their doctor if physical therapy is an option. I do feel that physical therapy here at Orange Coast can help you stay on your feet, keep you healthy and maybe save your life. Not everyone likes to exercise, but we keep it fun and we motivate you and we're sensitive to what you can and cannot do.

Melanie Cole, Host: Absolutely great information. So important for listeners to hear because so many people do experience this. So thank you so much, Mitchell, for coming on. That wraps up this episode of Weekly Dose of Wellness with MemorialCare. Head on over to our website at memorialcare.org for more information on the vestibular disorders program and to get connected with one of our providers. If you found this podcast as informative as I did, I know that you know someone who has these kinds of dizziness or balance issues. So be sure to share on your social media and be sure to check out all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.