Vestibular Disorders: From Cause to Cure. Proceedings From the 10th Biennial Conference of the National Center for Rehabilitative Auditory Research.

You have accessAmerican Journal of AudiologyIntroduction1 Nov 2023Vestibular Disorders: From Cause to Cure. Proceedings From the 10th Biennial Conference of the National Center for Rehabilitative Auditory Research Timothy E. Hullar, Robert J. Peterka, and Dawn Konrad-Martin Timothy E. Hullar https://orcid.org/0000-0003-4880-7033 National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR Google Scholar More articles by this author , Robert J. Peterka National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR Department of Neurology, Oregon Health & Science University, Portland, OR Google Scholar More articles by this author and Dawn Konrad-Martin National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR Google Scholar More articles by this author https://doi.org/10.1044/2023_AJA-23-00137 SectionsSupplemental MaterialAboutAbstractPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In Loss of vestibular function is characterized by a constellation of symptoms including unsteadiness, vertigo, nausea, and oscillopsia. These symptoms can lead to physical injury, loss of autonomy, and chronic medical problems including cognitive loss and depression and cost, on average, over $60,000 per person (Agrawal et al., 2018). The decrease in quality of life associated with vestibular loss may equal or surpass that suffered by people with significant hearing loss (Soulier et al., 2017). Despite these alarming statistics, our progress in addressing vestibular disorders has not been as robust as our success in diagnosing and treating those with hearing impairment. Specifically, we still lack an adequate understanding of the pathophysiology of many vestibular disorders, sensitive and specific diagnostic techniques, and treatment modalities. This special issue of the American Journal of Audiology is centered on vestibular disorders, based on presentations at the 10th biennial national conference of the National Center for Rehabilitative Auditory Research (NCRAR) located at the Portland VA Medical Center in Portland, Oregon, in September 2021. The conference aimed to bring together an audience of audiologists, physical therapists, otolaryngologists, neurologists, physiologists, and epidemiologists together with early-career investigators and students to bring participants up to date on the existing state of the field, identify critical places where progress can be made, and develop leaders in each of these aspects of clinical and basic vestibular science. The conference organizing committee included Drs. Dawn Konrad-Martin (conference chair), Robert Peterka and Timothy Hullar (co-chairs), Candice “Evie” Ortiz, and Devin McCaslin. It was supported by NIH grant R13DC019837 from the National Institute on Deafness and Other Communication Disorders. Due to the COVID-19 pandemic, the conference was held exclusively virtually. As in previous years, no concurrent talks were scheduled in order to allow all participants access to the entire conference. Each of the 13 scientific talks lasted 50 min followed by 10 min of questions. The 15 poster presenters were available at specific times to describe their work, although the posters could also be visited asynchronously. Virtual smaller breakout rooms allowed focused discussions among participants, students, and presenters. The five-member conference organizing committee included two women, with one a woman of color; of the 17 speakers and panel discussants, two were women of color and one was a man of color. Eight of the sixteen poster presenters were students. 29 registrants were students with 16 receiving scholarships. Six were male and 23 were female. Three students described themselves as Asian, two as Black, and five as more than one race. Of the 253 registrants overall, 65 responded that they were male, five were nonbinary, and 175 were female. 21 described themselves as Asian, 11 as Black, 195 as Caucasian, and seven described themselves as being of more than one race. For the first time, the conference included a dedicated session addressing diversity, equity, and inclusion (DEI) in our field. The keynote speaker for this portion was Dr. David Brown, MD, associate dean for health equity and inclusion at the University of Michigan, who spoke on “Seeking Balance in Research and Clinical Care.” An interactive session, entitled “Barriers to DEI in Communication Sciences and Disorders: What Are They and Where Do We Go From Here?” included Teresa Girolamo, PhD, of the University of Connecticut; Candice “Evie” Ortiz, AuD, and Ken Grant, PhD, both of Walter Reed Army Medical Center; and Lloyd Minor, MD, of Stanford University. A critical lesson from their presentations was that a team built around the principles of DEI brings a range of opinions, experiences, and skills that naturally enhance the scope, quality, and applicability of the team's work. Dr. Brown and the other participants emphasized several critical steps to improve an organization's ability to meet its DEI goals: (a) understand DEI will not happen by itself and that active engagement and recruitment is necessary; (b) recognize that retaining successful members of a DEI-oriented team requires proactive monitoring and encouragement; (c) hire with a goal of building complementary teams to help recruitment; and (d) do not wait passively for DEI efforts to occur—instead, start by identifying at least one specific barrier and strive to remove it from the workplace. A copy of the document, “Resources and Strategies for Promoting Diversity, Equity, and Inclusion in Audiology and Rehabilitation Services,” is available in Supplemental Material S1. The first day of the conference focused on causes of imbalance. The day's keynote speaker, Ken Burns, PhD, came from a position in industry to speak on cellular mechanisms of peripheral vestibular loss and regeneration. Faith Akin, PhD, of the Mountain Home VA, discussed the effect of head trauma on imbalance; Jeffrey Sharon, MD, of University of California San Francisco, described the pathophysiology of superior canal dehiscence; Christopher Zalewski, PhD, reviewed the relationship of aging to vestibular loss; and Courtney Voelker, PhD, MD, discussed the effect of Ménière's disease on imbalance. The second day of the conference focused on diagnosis of imbalance. The day began with compelling patient interviews describing their clinical experiences with dizziness and imbalance (often recalling their difficulty finding knowledgeable specialists able to offer them quality care). Devin McCaslin, PhD, the day's keynote speaker, generated enormous enthusiasm for his development of an automated triage system for dizzy patients using artificial intelligence. Faisal Karmali, PhD, explored the use of the promising novel modality of psychophysical testing to measure vestibular function, and Kamran Barin, PhD, described the clinical uses for video head impulse testing as a keystone measure in vestibular evaluation. Psychiatric disorders related to vestibular function were described by a world leader in the field, Jeff Staab, MD, and Joel Goebel, MD, discussed vestibular migraine, a common cause of intermittent dizziness seen by audiologists and otolaryngologists that affects up to 10% of patients in clinics specializing in dizziness (Huang et al., 2020). The day concluded with a well-received round table where audience members presented their challenging patient cases to a group of conference presenters comprising audiologists, physical therapists, and physicians. They drew upon their clinical expertise to share their ideas and opinions about each patient's diagnosis and management with the audience. The third day of the conference focused on treatment. Susan Whitney, PT, PhD, a world leader in vestibular rehabilitation and the day's keynote speaker, discussed her use of virtual reality technology in caring for patients with vestibular loss. Michael Schubert, PT, PhD, described central compensation after vestibular loss, and finally, Charley Della Santina, PhD, MD, developer of the Hopkins vestibular implant now in clinical trials, reported the success of his technology in treating patients with severe vestibular loss. While the conference served as a reminder of the immense health-related impact of vestibular loss, it also provided the following optimistic observations: First, our understanding of the cellular and molecular pathologies behind many vestibular conditions is developing rapidly—and with it, opportunities to mitigate their effects. Second, advanced surgical and pharmacologic treatments are increasingly effective in caring for many patients with vestibular problems. Third, improved physical therapy techniques can help even those most frustrating—and frustrated—patients, such as those suffering from head trauma. Fourth, the advent of a vestibular prosthesis may revolutionize the care of patients devastated by peripheral vestibular loss. Presentations and discussions at the conference also highlighted areas where future efforts may be focused. First, we must work to develop diagnostic tests that are more sensitive, specific, reproducible, and relevant than the ones currently available. Second, we should concentrate on conducting trials of balance interventions, such as pharmacotherapy or physical therapy, but remembering that randomized controlled trials are not always necessary to identify a clinically important effect. Third, we should improve systems-based practice, including better triage systems and better use of multidisciplinary teams, to accelerate diagnosis and reduce costs and morbidity. Fourth, we should maintain and expand relevant tissue repositories, encouraging the careful collection of specimens from donors with vestibular problems into temporal bone collections. The articles in this special issue represent the work of established leaders and students in the field. The work by Behr and Honaker (2023) discusses the successful management of a patient with recalcitrant benign paroxysmal positional vertigo using an omniaxial chair to perform canalith repositioning maneuvers. Kirjava, Sladen, and DeBacker's (2023) article identifies barriers and offers guidance for providing audiologic care to the 7% of Americans who identify as lesbian, gay, bisexual, transgender, queer, and other identities. Talian et al. (2023) provide, in one place, extensive norms for conventional vestibular testing in a large group of healthy adults—a dataset that may provide important correlations in future work. Faith Akin, also one of the conference presenters, and co-authors (Akin et al., 2023) show that risk factors for postconcussive dizziness among Veterans included lower educational level, race, diagnosis of posttraumatic stress disorder, and hearing and vestibular loss. The article by Shah, which includes conference presenters Jeffrey Staab and Devin L. McCaslin as co-authors (Shah et al., 2023), demonstrates that a multidisciplinary care team was generally successful in relieving dizzy symptoms in a mixed group of patients, although anxiety and depression remain largely unchanged. Faisal Karmali, who presented an introduction to vestibular psychophysics at the conference, joins co-authors Susan A. King and Elena Lopez-Contreras Gonzalez (Gonzalez et al., 2023) to show that psychophysical thresholds can be overestimated due to cognitive biases—a finding that could have dramatic implications for the rapidly growing field of vestibular psychophysics. Benjamin, Gardi, and Sharon (2023), a conference presenter, describe an outcome measure, the Vestibular Migraine Patient Assessment Tool and Handicap Inventory, they have developed for patients with vestibular migraine. Finally, Janky and Steyger (2023) review the mechanisms and impact of aminoglycoside-induced vestibular loss, a key model for ototoxicity as well as a public health concern whose importance is increasingly recognized. Acknowledgments Supported by NIH R13DC019837 (PI: Konrad-Martin) and VA Rehabilitation Research and Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR; Center Award #C2361C/I50 RX002361) at the VA Portland Health Care System in Portland, Oregon. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs. References Agrawal, Y., Pineault, K. G., & Semenov, Y. R. (2018). Health-related quality of life and economic burden of vestibular loss in older adults.Laryngoscope Investigative Otolaryngoly, 3(1), 8–15. https://doi.org/10.1002/lio2.129 CrossrefMedlineGoogle Scholar Akin, F. W., Swan, A. A., Kalvesmaki, A., Hall, C. D., Riska, K. M., Stressman, K. D., Nguyen, H., Amuan, M., & Pugh, M. J. (2023). Factors that impact the long-term outcome of postconcussive dizziness among post-9/11 Veterans.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2023_AJA-22-00150 ASHAWireGoogle Scholar Behr, E., & Honaker, J. A. (2023). When particle repositioning maneuvers just will not stick: Clinical considerations for persistent benign paroxysmal positional vertigo.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2022_AJA-22-00118 ASHAWireGoogle Scholar Benjamin, T., Gardi, A., & Sharon, J. D. (2023). Recent developments in vestibular migraine: A narrative review.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2022_AJA-22-00120 ASHAWireGoogle Scholar Gonzalez, E. L-C., King, S. A., & Karmali, F. (2023). Your vestibular thresholds may be lower than you think: Cognitive biases in vestibular psychophysics.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2023_AJA-22-00186 ASHAWireGoogle Scholar Huang, T. C., Wang, S. J., & Kheradmand, A. (2020). Vestibular migraine: An update on current understanding and future directions.Cephalalgia, 40(1), 107–121. https://doi.org/10.1177/0333102419869317 CrossrefMedlineGoogle Scholar Janky, K., & Steyger, P. S. (2023). Mechanisms and impact of aminoglycoside-induced vestibular deficits.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2023_AJA-22-00199 ASHAWireGoogle Scholar Kirjava, S. A., Sladen, D. P., & DeBacker, J. R. (2023). Providing mindful and informed health care for patients who are LGBTQ+: Perspectives for clinical audiology.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2023_AJA-22-00112 ASHAWireGoogle Scholar Shah, M., Staab, J., Anderson, A., Eggers, S. D., Lohse, C., & McCaslin, D. L. (2023). Outcomes and patient experience in individuals with longstanding dizziness.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2023_AJA-22-00152 ASHAWireGoogle Scholar Soulier, G., van Leeuwen, B. M., Putter, H., Jansen, J. C., Malessy, M. J. A., van Benthem, P. P. G., van der Mey, A. G. L., & Stiggelbout, A. M. (2017). Quality of life in 807 patients with vestibular schwannoma: comparing treatment modalities.Otolaryngoly—Head and Neck Surgery, 157(1), 92–98. https://doi.org/10.1177/0194599817695800 CrossrefMedlineGoogle Scholar Talian, D. S., Eitel, M. M., Zion, D. J., Kuchinsky, S. E., French, L. M., Brickell, T. A., Lippa, S. M., Lange, R. T., & Brungart, D. S. (2023). Normative ranges for, and interrater reliability of, rotational vestibular and balance tests in U.S. Military Service Members and Veterans.American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2022_AJA-22-00128 ASHAWireGoogle Scholar Author Notes Correspondence to Timothy E. Hullar: [email protected] Disclosure: The authors have declared that no competing financial or nonfinancial interests existed at the time of publication. Editor-in-Chief: Erin M. Picou Publisher Note: This article is part of the Special Issue: Select Papers From the National Center for Rehabilitative Auditory Research Conference. Additional Resources FiguresReferencesRelatedDetails Volume 32Issue 3SNovember 2023Pages: 671-673Supplemental Material HistoryReceived: Jul 6, 2023Revised: Aug 6, 2023Accepted: Aug 7, 2023 Published online: Oct 6, 2023 Published in issue: Nov 1, 2023PubMed ID: 37801692 Get Permissions Add to your Mendeley library Metrics Topicsasha-topicsasha-article-typesCopyright & PermissionsIn the Public DomainPDF downloadLoading ...