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Equinox is a physical therapy practice in Sarasota, Florida. We specialize in treating people with dizziness, vertigo, balance problems and facial paralysis.

Wednesday, 27 August 2014 18:45

Balance Awareness Week, Sept 15th-21st, 2014

Balance Awareness Week is September 15th-21st, 2014!Balance Awareness Week

Are you having a balance problem? The goal of balance awareness week is to help people recognize if they are having a problem, and to urge them to seek help. Falling is not a normal part of aging. We know that falls can lead to serious injuries and even death. If you have had one fall with serious injury in the last 12 months, or 2 falls without injury, I encourage you to seek out a professional vestibular balance specialist. Something can be done to help your problem!


Friday, 15 August 2014 18:06

Facial Paralysis and Inner Ear Conditions

Facial paralysis occurs when the facial nerve is damaged and unable to send messages to the muscles of the face that create facial expressions. This problem can occur for several different reasons. Some causes include: tumor, trauma, stroke, or genetic disorders.
Facial Paralysis and Inner Ear Conditions
The most common cause of facial paralysis is due to Bell Palsy. While most of the time, Bell Palsy patients recover fully, research tell us that about 20-30% have lasting weakness or paralysis.

I first started treating people with facial paralysis because I was a vestibular specialist. The vestibular system or inner ear balance system is innervated by cranial nerve 8 (the Vestibular Nerve). The muscles of the face used for facial expression are innervated by cranial nerve 7 (the Facial Nerve). These 2 nerves run side by side on their way to the brain in a tunnel in the bone called the Internal Auditory Canal (IAC). This is a very narrow space, with only enough room for the nerves to travel. If a tumor is growing in this small place, or an infection travels to this area, both nerves can be damaged. We see this with large acoustic neuroma tumors, or with infections such as Ramsey Hunt Syndrome.

When facial paralysis does occur, it can take a lot of time for the nerve to heal. The first signs of movements of the face can be only just a flicker, but as the nerve heals, the movements can become stronger. Working with a physical therapist who has special training in treating facial paralysis can help improve the outcome for patients with this problem. They can teach a person what to expect while they are recovering, how to do stretches to ease pain and tightness in the face, how to retrain the muscles to move in a symmetrical way with the unaffected side of the face, and how to manage a condition called synkinesis (when facial muscles which should not be working when making a certain expression try to “help” anyway).

*Sculpture by Jun Kaneko 2007, Untitled Head in Glazed Ceramic and Steel

This is the title of a radio interview I did on July 1st, 2014 with Heidi Godman on her radio program Health Check on WSRQ Sarasota Talk Radio. She interviewed me, and also my husband Dr. Jack Wazen who is an MD, to discuss answers and treatment advice on balance and dizziness problems. During the podcast, I shared with Heidi how physical therapy can treat these problems, and Dr. Jack Wazen talked about the medical side of diagnosing and treating specific balance or dizziness problems. Conditions we discussed included Meniere’s Disease, BPPV, labyrinthitis, and tumors.

Cilck here to go to the Sarasota Talk Radio WSRQ website, where you can find Heidi Godman’s Health Check program, which was recorded on July 1, 2014. I hope you enjoy listening to the program as much as I enjoyed making it.

U-STEP: A WALKER DESIGNED FOR PARKINSON’S PATIENTS by Laura Wazen and Charlie

 

Hi.  My name is Laura Wazen and this is my friend Charlie.  Today we want to show you a very cool walker you may not have seen before, that is especially good for people who are having Parkinson’s Disease.  So, one of the things about Parkinson’s Disease, is that sometimes, it can be a little bit hard to control your momentum if you’re walking with a traditional walker- that is in a sense, rolling away from you.  So the neat thing about this U-Step walker is that it will only move if you squeeze the handles.  So if Charlie wants to take a step, he squeezes the handles, and takes a couple of steps forward.  Now the neat thing about this is, if he’s feeling unsteady or needed to stop, all he would have to do is release the handles.  And then he could regain his balance, and he can then take a step forward which is a really, really cool thing!  Another neat thing about this walker is that if a person is having a problem taking a step forward, (they’re freezing for example), it has a little button, which is right here, that if you push the button, it puts a red laser on the floor that serves as a visual cue, so that you can just look down and see the red line, and then the person initiates a step by stepping over the line.  Charlie, could you push the button on the laser?  (Charlie demonstrates pushing the button).  The laser would project on the ground, and then he could use that red line as a visual cue to take a step, and start walking again.  There you go. 
Very good, Charlie.

Thursday, 03 July 2014 14:36

NEW OFFICE LOCATION!!!

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We have moved our office to 950 South Tamiami Trail, Suite 101, Sarasota, FL 32439. It is a great space with lots of windows, ample parking in the shade (which is huge if you live in Florida), and on the 1st floor of the building.

The new office is right on US 41 South, across the street from the old Sarasota High School Building. I am really pleased to be opposite such a great Sarasota landmark, because the old school is now the new home for the Sarasota Museum of Art (SMOA)!

What does this mean for me? Well, I won’t have to go far to see inspiring art. In fact, if you are sitting in my treatment room, you can see a fascinating art installation right on the front lawn of the museum. I thought you might enjoy it as much as I have, so below you can see some of the photos I took with my phone the other day. As you can see by the pictures, this makes giving directions to my clinic very easy…

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I have driven by this exhibit hundreds of times, but actually being able to walk in and around the art, and touch the walls of the structure gave me a whole new personal experience to the art work.  If you live in Sarasota, I highly recommend you take 5 minutes, and stop and do the same.  While you’re at it, stop by my office to say hello!

 

 

 

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Saturday, 24 May 2014 23:44

What is Balance Therapy?

536aa267b3db6.preview-300Generally speaking, balance therapy is a type of physical therapy that is performed to help a person with a balance problem. Different therapists may approach treating a balance problem based on their own background and expertise. For example, a therapist who comes from an orthopedic background and loves treating mainly people with joint and muscle problems, will tend to do what makes their other orthopedic patients better. That is, put the patient on a bike, and give them leg exercises. If the patient’s balance problem is caused by muscle weakness, they will improve.

However, if the problem is not weakness, they will not improve. It is not unusual for me to get a patient for balance therapy in my Sarasota office, and for the patient to say straight out that they don’t think I will be able to help them, because they have had a lot of physical therapy and did not get any better. The next question I ask is, “Well, tell me what you were doing?”, and 9 times out of 10 they will say sitting on a stationary bike and using machines to strengthen their legs. I usually tell that person, well, good, I am glad to hear that the exercises I have in mind you haven’t done before, so there is still a chance that you will get better.

What are these exercises? They include inner ear balance exercises. Our inner ear system is the major organ in our body that powers our balance. It tells our brain when our head or body is moving, so that the brain can tell the joints and muscles how to move to maintain balance. A classic inner ear exercise is to improve the vestibular-ocular reflex, or VOR. This is a reflex between the ears, the eyes, and the brain. Just to explain it a bit… If a person looks at a target and moves their head side to side, they are stimulating their VOR. The inner ear sends messages to the brain to tell the brain how far or how fast the person is turning their head, and the brain uses this information to coordinate the person’s eyes on the target while the head is turning. If the VOR was not working properly, then when the person turns their head, instead of keeping their eyes on the target, they would find that they are looking in the direction of the head turn. If the person’s VOR is not working properly, the patient could have complaints of dizziness, and be unsteady when walking, especially if turning their head to look at something to the side. Another exercises involves keeping the head still, but watching a moving target. If you would like to see this exercise demonstrated, click here to check out the segment on falls and balance that I recently did for ABC News 7.

According to the CDC, one out of three adults age 65 or older suffer falls each year.

These are only a couple of examples of exercises that improve one’s balance. I know it may sound complicated, but it makes perfect sense. If you have a good balance physical therapist, they should know these exercises and include it in your program to make your ability to use inner ear information stronger. This is just one example of how working with a qualified balance and vestibular therapist, and not just someone who went to PT school, can make all the difference. 

Related Article: Trips and falls cause millions of injuries a year

Sitting old man waiting in hall by Abraham van Strij

Sitting old man waiting in hall, by Abraham van Strij

 Medicine and technology are amazing. People who are deaf can get cochlear implants to restore their hearing, while others get corneal implants for their eyes. There are hip and knee replacements for arthritic joints, and the list goes on… If you have in inner ear balance problem, you may be wondering, “When will someone make an implant to restore my balance?"

Well, Dr. Jay Rubinstein from the University of Washington is definitely one of the researchers in the know. A few years ago, I met Dr. Rubinstein at a University of Colorado ENT meeting. At that time, he was reporting on his early results from implanting human subjects with his vestibular device. When I saw him again in February 2014, he was kind enough to give me an update.

His first studies were done on rhesus monkeys that had healthy inner ear systems with intact hearing and balance function. In order to start testing the device on human subjects, the device needed approval from the Food and Drug Administration (FDA), and the study had to pass strict scrutiny by an institutional review board (IRB) to prove that the research was ethical and would not harm the subjects involved. Dr. Rubinstein had to find a population of people who from a hearing and balance point of view had nothing to lose and everything to gain by participating in the study.

The first group of 4 people to be implanted had a condition called Meniere’s Disease. These patients had already lost their hearing and vestibular function (inner ear balance control) due to Meniere’s Disease before they were implanted. He has now been following these initial patients for one to three years. Because the device can be turned on and off, Dr. Rubinstein compared how the device benefits the person’s balance control, and also how the device improves the ability of the person to stabilize their vision and decrease the visual bouncing phenomenon called Oscillopsia. Oscillopsia is kind of like the effect one would get if watching an amateur video that someone took as they were walking down the street. It looks as if the world is bouncing. One goal of the implant is that by restoring inner ear function, the oscillopsia would stop.

So you must be wondering, what did he find? Dr. Rubinstein found that over time, the electrical response from the device declined. Based on these findings, he adapted the vestibular implant to make the responses generated more robust.

Sounds great, right? But not so fast. Because research on human subjects is very, very regulated, Dr. Rubinstein has to go back to the FDA to get the new device approved, and then has to submit a whole new IRB research protocol for approval! Once that hurdle is jumped, the next hurdle is funding. As you can imagine, this type of research is very expensive and takes a lot of money…

So you see, research takes perseverance. Dr. Rubinstein certainly has that! I am very grateful that he took the time to talk with me, and has allowed me to share these things with you! I told him that my patients are always asking me when there will be a cure for their problem, and I tell them – “they’re working on it...” Truly, hope is on the horizon.

Wednesday, 07 May 2014 17:24

Equinox Physical Therapy on ABC 7 News

Breaking long

Breaking News! Hi, Everyone. I was just interviewed for a segment on Balance by Alix Redmonde from ABC News 7. For those of you who live in the Sarasota/Tampa area, you can check out the segment tonight during the prime time evening news. Alix says the segment should run at 5:40 pm, although sometimes the health segments can be shown at 5:30 pm. If you are around, check it out!

Cliff near Dieppe 1985 Paul Gauguin

Cliff near Dieppe 1985, Paul Gauguin

Vertigo, Dizziness, and Dysequilibrium. These words mean different things to different people. However, if you are using these words in the medical sense of things, understanding the definition will help you communicate more precisely when talking with your doctor or physical therapist.

VERTIGO is a spinning sensation, either that you are still and the world is spinning, or that the world is still but you are spinning. If things aren’t spinning, then saying you have vertigo is not quite right.

DIZZINESS has to do with a funny feeling in the head, but nothing is spinning.

DYSEQUILIBRIUM has nothing to do with dizziness, or vertigo. People with dyequilibrium have no dizziness or vertigo, but they are unsteady walking.

Hopefully these definitions will help you in explaining your symptoms!

Tuesday, 22 April 2014 20:29

Crystals in the ears?

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Crystal, 1921 Watercolor by Paul Klee

My physical therapy clinic in Sarasota, Florida sees many patients who are surprised to learn that they have crystals in their ears, and yes, they are supposed to be there! The crystals are made of calcium carbonate, and are called otoconia. Under an electron microscope they look like little grains of rice.

The crystals sit on top of the nerve cells in the ear. The purpose of these crystals is to help stimulate the nerve when the inner ear fluid whooshes over the nerve in response to movement. However, if these crystals come loose and start floating in the ear canals where they don’t belong, this can trigger vertigo.

Vertigo is a sensation that the world is spinning around you, or that the world is still but you are spinning. The name of the condition is Benign Paroxysmal Positional Vertigo (BPPV). The vertigo sensation is triggered by motion, and it usually lasts just a few seconds. Treatment for this problem consists of maneuvers to guide the crystals back into the part of the ear where they belong.

Once there, we want the crystals to sink back into a jelly-like matrix on top of the nerve cells, so that they stick in place and stay where they belong. Once back in place, life returns to normal, and the vertigo episodes cease.

Thursday, 03 April 2014 15:20

Will my vertigo come back?

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My Eyes in the Time of Apparition, 1913. By August Natterer

This is one on the most frequent questions that my patients in Sarasota, Florida ask me, “Will my vertigo come back?” It is the question they usually ask right after I tell them that their BPPV (Benign Paroxysmal Positional Vertigo) was successfully treated, and is now gone. Research tells us that in about 40% of cases, the condition will come back. Sometimes it can come back within a year, other times the person can go for many years before the condition returns.

The next question is usually, “Is there anything I should avoid doing so that the vertigo doesn’t return?” There is nothing that the person does that makes it come back, it just does. So in that case, I tell my Sarasota BPPV patients that they should go back to life as normal. That means sleeping flat like they normally did before all this started, and to resume all their normal every day activities. This includes bending over, for example to pick something up off the ground, or tipping their head back as they would to reach over head.

If the condition does return, the person will just need to call and come back to therapy to have treatments to put the crystals back in place again. Knowing that they have a plan of what to do if the BPPV returns, usually takes the fear away, and allows the person to go on with their lives- which is the goal after all…

This is a frequent question that many of my patients ask me. Antivert, Meclizine, Bonine, and Dramamine are all drugs that can be bought over the counter to treat dizziness. But the question is, when should a person take these drugs?

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To answer this question, one must first understand how these medications work. These drugs decrease or prevent dizziness, by blocking signals FROM the inner ear TO the brain. If a person is having a full blown vertigo attack, these drugs may be necessary, and may be prescribed by your doctor. However, once the attack is over, continuing to take these medications can interfere with one’s recovery.

For instance, when a person comes to physical therapy to treat an inner ear disorder, the purpose of the therapy is to teach the brain how to respond better to inner ear signals in order to improve one’s balance and decrease one’s dizziness. In other words, we want the inner ear to be able to send signals to the brain, so that the brain can learn how to adjust and use inner ear information again.

If a person is taking one of these drugs, then the medication is actually blocking the very signals that the brain needs in order for the person to get better. Therefore, in most cases, it is not advised to take these medications. In fact when used chronically, these medications can actually prevent or delay recovery.

*Disclaimer: The above recommendations reflect basic treatment philosophy when working with patients with inner ear disorders. Since physical therapists do not dispense medications, further specific questions about your medication regimen should be directed to your personal physician.

Thursday, 06 March 2014 16:37

Free Balance Lecture in Sarasota 3/8/2014

Hi, everyone. I just wanted to let you know that if you live in Sarasota or Manatee County in Florida, there is a great event going on this weekend. It is the called the 3rd Annual Hearing Tech Expo, held on Saturday, March 8, 2014 from 9am-4pm.

Over 50 vendors who help people with hearing loss will be present. There will also be 14 seminars taking place. I will be giving one of the seminars, and the title of my talk is “Understanding Balance Problems, and what to do about them”. My talk is at 1:30 pm in the main auditorium of the Manatee Technical Institute (located on State Route 70, just west of I-75, and east of route 301).

This is a super event, and I hope you can make it. It is sponsored by the Hearing Loss Association, whose purpose is to educated, support, and advocate for the over 135,000 people who live in Sarasota and Manatee counties. Hope to see you there!

expo flyer

Monday, 24 February 2014 16:02

Does Wearing a Hearing Aid Help My Balance?

We know that people use information from other senses to help them balance. For instance, we use our vision to help us balance. When we walk outside today, and see that the sidewalk is sloping, we will automatically adjust our steps and our balance based on this information.

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But how does one’s hearing affect their balance? A study appeared in the Archives of Internal Medicine Feb 28, 2012 about research out of Johns Hopkins Medical Institution. They studied 2,000 people between the ages of 40 to 69. The people had their hearing tested and were asked questions about if they had fallen in the past year.

(Pictured: an antique ear trumpet for the hard of hearing.)

The results confirmed the contribution that hearing makes to balance. In this study, the researchers found that even people with a mild hearing loss (25 decibels) were nearly 3 times more likely to have a history of falls than those without a hearing loss! They were also able to measure how as the hearing decreased, the risk of falls increased. For instance with every 10 decibels of hearing loss, the risk of falling increased by 1.4 fold! 

Many people don’t want to wear their hearing aids, for many various reasons. But when they understand that wearing the hearing aids will decrease their risk of falls and injury, they are usually much more willing to put them on…

Thursday, 30 January 2014 21:00

Cool Bike Tricks for Balance Video

Do you need inspiration to improve your balance? Then check this out:

 

 

So many times we want to make positive changes, but they seem impossible. This is true when working on improving one’s balance too. When I was in Miami for the Triologic Meeting in January 2013, I was walking down the street, and there on the corner of Lincoln Avenue was balance inspiration at it’s best. What these guys were doing seemed impossible, but they made it possible! I hope watching this video encourages you to never give up, and to keep doing your balance exercises!


Sculpture by Auguste Rodin- Die Buerger von Calais
 
A sudden problem with one’s inner ear system can cause symptoms such as vertigo, dizziness, nausea, vomiting, and difficulty walking.  We have always understood that when both ears are normal, the brain gets the same amount of information from each ear, and therefore does not have these symptoms.  However, when a person suddenly gets an inner ear problem in one ear only, the information sent to the brain from each ear is no longer the same amount from each side.  This imbalance of information results in the symptoms of dizziness, nausea, vertigo, and difficulty walking.   Putting myself in the other person’s shoes, it seemed natural to me that anyone with these symptoms could feel anxious, emotional, fearful, and worried.  But why is it that some people experience more anxiety than others?
 
Last November while attending the Politzer Society Meeting in Antalya, Turkey, I was fortunate to run into a colleague named Dr. P. Ashley Wackym.  He is an otologist, (a surgeon who specializes in inner ear problems), who practices at the Ear and Skull Base Center in Portland, Oregon.  I asked Dr. Wackym if he is involved with any new and exciting research on inner ear problems.  He shared with me that research from his center is now showing that when a person has a sudden or fluctuating inner ear problem in one ear only, that this asymmetry of information that is reaching the brain can cause issues with another part of the brain called the hippocampus. The 3 top things that this trouble with the hippocampus causes is as follows:  cognitive dysfunction, spatial disorientation, and anxiety.   I have seen this with my own patients who complain of difficulty concentrating, feeling clumsy when moving through space, and feeling emotional, tearful and anxious.  Dr. Wackym states that the anxiety occurs with more severe inner ear vestibular asymmetries, and that the anxiety felt is extreme.  Patients may describe a feeling of impending doom, or that something really bad is going to happen.  The good news is that when the brain recovers, and adjusts to the change of information received from the two ears, the hippocampus also returns to normal function, and the anxiety, difficulty concentrating, and spatial disorientation improve; however, this can take some time.  Dr. Wackym says that once his patients understand why they are having these symptoms and that things will get better as they recover, they feel greatly relieved.  It decreases their concern, and lets them know that there is a medical reason for their feelings, that they aren’t crazy, and that things will get better.  
Thanks for update, Dr. Wackym!
Thursday, 26 December 2013 00:00

New Ear Research

From Dr. Anil Lalwani at Columbia Presbyterian Hospital in New York City

 

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In November, 2013, I traveled to Anatalya, Turkey for the 29th Politzer Society Meeting.  I was so fortunate when on the bus from the airport to the conference center, I ran into Dr. Anil Lalwani from Columbia Presbyterian Hospital.  Dr. Lalwani is an otologist, (an Ear Nose and Throat physician who specializes in the treatment in inner ear problems), and Chief of the Division of Otology, Neurology, and Scull Base Surgery.  I was asking him,  “So what’s new?  Do you know of any exciting new research or treatments on the horizon that might be able to help my patients in the future?”  I was so happy to hear him say the word, “YES”!   Dr. Lalwani described to me the exciting research that is coming out of his lab at Columbia.  He and his team are developing tiny needles that can be used to access the inner ear.  One application for these needles is for diagnosing disorders that may be happening in the ear.  These needles will be able to collect inner ear tissues and fluids, which can then be analyzed to diagnose signs of disease.  Another application of the needles is to deliver medications directly to the inner ear, for example, aspirin.  Currently, medications to treat inner ear problems are given systemically by mouth, by IV, or they diffuse into the inner ear when injected into the middle ear.  Being able to deliver medication directly to the inner ear cochlea or to the vestibular balance system is indeed an advancement in treatment. 

     I will keep you posted on Dr. Lalwani’s research developments, and when this new technology will be ready and available for patients.  If you live in the New York City area, and need an excellent physician, with the tools at his fingertips to diagnose and treat your problems, I highly recommend Dr. Anil Lalwani.  His contact number is 212-305-5820.  He will also be able to help you find the right audiologist, or physical therapist to meet your needs. 

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Turkish coffee break- Politzer Society Meeting 2013, Turkey

 

 

 

Wednesday, 18 December 2013 00:00

Vestibular Excellence in the Middle East

I am happy to announce the realization of a dream! I have been traveling to the American University of Beirut Medical Center for several years now. My husband was going to give grand rounds in the Ear, Nose, and Throat (ENT) Department at the hospital a few years back, and I said, “Do you think that they would like to hear from a physical therapist about how to work with patients with vestibular disorders?” When he asked the department, they invited me to speak as well! I talked about vestibular rehabilitation, and how doctors, physical therapists, and audiologists can form the most effective and comprehensive team to treat individuals with inner ear balance problems. The talk was wonderfully well received. Before I knew it, their physical therapy director (who also happened to be the President of the Lebanese Physical Therapy Association), Ms. Claude Maroun, and their ENT physicians began imagining how to bring the first center of its kind to the Middle East. They were committed to making this dream come true. Each time I would return to Beirut, I would meet again with the doctors and therapists, at times just brainstorming, or lecturing, or working with their vestibular therapist in training.

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Beautiful Beirut

Earlier this year, I got an email from Claude Maroun stating that they were sending a therapist to Florida for 3 weeks of training! Wow! This was huge. Youssef Koaik came in March 2013, attended a course for 1 week, and afterwards spent 2 weeks in training with me at Equinox Physical Therapy and with the team at the Silverstein Institute.

Currently, I am in Turkey at the Politzer Society Meeting. To my great joy, the ENTs from Beirut, (now old friends) are in attendance as well! What a happy reunion! When I saw Dr. George Zaytoun, head of ENT, I couldn’t wait for the update on the vestibular program. He was pleased to inform me that his colleague, Dr. Marc Bassim, has been appointed the medical director of the new Balance Center. For those of you unfamiliar with these two gentlemen, let me fill you in. They have done their training in the USA at two of the finest medical institutions for ENT in the world (Dr. Zaytoun at Massachusetts Eye and Ear Infirmary, and Dr. Bassim at the House Clinic). But the biggest news is that the center will be opening in January 2014, and they have spared no expense in providing their patients with the most sophisticated equipment available. For instance, they have a Rotary Chair Test, Posturography Machine, Otometrics Video Head Impulse Test, VNG machine, VEMP machine, and audiogram. All in all, I am estimating a quarter million US Dollars in equipment alone! There are only a few centers worldwide that have this level of sophisticated technology at their fingertips. This, in addition to their highly trained and accomplished MDs, PTs, and audiologists, make them a formidable team in treating disorders of the inner ear.

Can you imagine, that from one talk a few years ago, they have built this center? They are remarkable and inspiring! I know that they will blaze a trail of excellence in the Middle East, and the world at large. I will definitely keep you posted on their developments, as I feel they are the ones to watch! If you live in the Middle East, you now have someplace closer to home to go when you have inner ear vertigo, dizziness, or imbalance problems. Nushkur alla (thank God).

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2009 Physical Therapy Department - Beirut. Claude Maroun, Laura Wazen, Youssef Koaik.

Thursday, 02 January 2014 00:00

Benign Paroxysmal Posititonal Vertigo- BPPV

So, what should be the first topic for my Blog? That’s easy BPPV! Why BPPV? I am choosing this topic because it is the most common type of inner ear disease. Of all inner ear disease, it takes up about 25% of all inner ear conditions. Also, it is the easiest to treat! BPPV stands for Benign Paroxysmal Positional Vertigo. BENIGN, meaning it is not life threatening and will not kill you. PAROXYSMAL, meaning the symptoms come and go. POSITIONAL, meaning the symptoms are triggered by a change in head or body position. And VERTIGO, meaning the person complains of a spinning sensation.

So many times people come to me and say, “they told me I have something wrong with the “crystals” in my ear”. Yes, that really sounds strange and like voodoo, but it’s not. There are crystals in our ears and they are supposed to be there! They are called “otoconia” and they are made up of calcium carbonate. They have to be seen with and electron microscope, because they are too tiny to see with the naked eye. Some people call them “ear rocks” because of their appearance. These tiny crystals can cause a heap of trouble when they become dislodged and start floating in the parts of the ear where they don’t belong. This will be better understood once you learn a bit about basic ear anatomy.

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Art is inspirational, and when I see these rocks, I can’t help myself! They make me think of otoconia!

Understanding the inner ear anatomy and BPPV

Lets start with the outer ear and work our way inward. Sound travels from the outer ear, down the ear canal, to the ear drum. It crosses the eardrum and is conducted by 3 little bones called the malleus, incus, and stapes to the cochlea. The cochlea is in the inner ear and is incased in the temporal bone of your skull. Sound information is processed in the cochlea, and then transmitted by the cochlear nerve to your brain, which then translates the information into what we know as sound. If you really want to be technical about it, we hear with our brains!

The other half of the inner ear is the balance part, and it is called the vestibular system. In the vestibular system, we have 3 canals that are filled with fluid. When we move, the fluid moves, and it stimulates the little nerve fibers, which look like tiny hairs. These 3 canals converge into a central area where there are nerve cells that sense gravitational forces. These structures are called the saccule and utricle. They have a gelatinous matrix on top, which is where the otoconia, (or crystals), are found. The function of these crystals is to help stimulate the nerve when our head changes position. The information then travels down the vestibular nerves to the brain and our brain uses this information to help us balance and coordinate head and eye movements. However, if these crystals break free and start floating in the canals of the ear where they don’t belong, then when a person moves in the plane of that canal, for instance, when bending over or tipping their head back, it causes an abnormal woosh of fluid across the nerve cell and triggers vertigo or a spinning sensation.

With BPPV, the vertigo, or actual spinning sensation last for seconds, usually less than a minute. Once the crystals float to the bottom of the canal, the spinning stops. But if you move your head again, you can get the spinning all over again. Gradually this symptom will fatigue.

So how is BPPV treated?

Well, many times is goes away on its own in a day or two. Other times, it can last for a long time and not go away unless it is treated.

To treat this, it first has to be diagnosed properly. There is a lot of information out there on the internet, and sometimes people try to treat themselves with varying degrees of success or failure. Diagnosing which canal the crystals are floating in takes knowledge and a clear understanding of the condition and it’s various presentations. For instance, a doctor or therapist will test to determine if the crystals are loose in your right ear, your left ear, or both ears. Once that is determined, the next thing to figure out is which of the 3 canals are the crystals loose in? This is very important because the treatment is different for each canal! With both ears combined, there are 6 canals that need checking in order to come up with the correct diagnosis. Therapists or doctors look at the pattern of eye movements that create the sensation of vertigo while in the test positions in order to determine which canal is affected.

Research tells us that the most common canal for BPPV is the posterior canal, which is affected in 80-85% of most cases. But the horizontal canal, or the anterior canal, are also possibilities. The test for BPPV is called the Hallpike Dix test (also called the Dix-Hallpike Test depending on who you ask). It is used to diagnose BPPV if the posterior or anterior canal is the culprit. Testing for the horizontal canal is done by the roll test.

Treatment for the posterior canal is done by the Epley Maneuver. It is a treatment named after a famous ear doctor named Dr. John Epley who was the first to present this treatment for this condition. He is a great guy, and I have met him on several occasions. He is getting older now, and is no longer in practice, but his techniques have helped so many people and have become the standard of care for posterior canal BPPV. There is another technique called the Semont Maneuver. This can be effective, and I will use this when a client is not responding to the Epley Maneuver. Brandt Darroff exercises are also used when the above techniques are not working for a client. The Brandt Darroff exercise is not a corrective treatment like the Epley or Semont. It works on the theory of habituation, which means with repeated exposure to the position that is provoking the vertigo, our brain will learn to become desensitized to the motion, and disregard the stimuli so that one can move in and out of positions that usually trigger vertigo and dizziness.

If you need to find a doctor or therapist near you who is familiar with treating BPPV, I recommend going to the Vestibular Disorders Association website. There, you can enter your area code and find a doctor or therapist in your area.

Thursday, 12 December 2013 00:00

Why Blog?

If you knew me, you would never in a million years think that I would be writing a blog. Up until 6 months ago, I didn’t even have a smart phone. I hadn’t bought a new cell phone in 15 years. So why blog? Good question. I have been fortunate enough to travel the world learning the latest in treatment and innovation for people with vertigo, dizziness, balance problems, falls, hearing problems, concussion, and facial paralysis. I benefit from this knowledge, because I love to learn! My patients also benefit from these travels, because they get the latest treatments for their issues. However, there are so many people out there that have no access to information that could potentially change their lives and give them hope for a cure. Many times the people who see me in my office say, “Why hasn’t anyone else told me that before?”.

By now, you are probably wondering who I am. I am a physical therapist who works with people with vertigo, dizziness, balance problems, falls, inner ear disorders, concussion, facial paralysis, stroke, and Parkinson’s Disease. I have been a therapist since 1998 and have a Doctorate Degree in Physical Therapy. I have worked in acute care hospitals, out patient facilities, and nursing homes. I opened my own practice, Equinox Physical Therapy in 2011, because I wanted to be in charge of how patients are treated from the moment they seek treatment until the time their therapy is completed. But, I don’t want this blog to be about me. I want it to be about you, that is, if you have any of the conditions I mentioned above…

But still you must be wondering, why blog? So what happened? Well, I was on a vacation to South Africa, and I met a fascinating young, talented woman who has started a blog relating to her business, which is about baking, decorating, and do-it-yourself crafts. If you love these things, you should check out her blog: Alanajonesmann.com. Her name is Alana Jones-Mann. She was sharing with me how many people she could reach with her blog ideas, and it clicked! I thought WOW- this is the answer to my question of how to share my unique experiences with the general public. I had considered starting a support group at my office, but this would only help the local people. Whereas a blog could help people all over the world and be free of charge. Also, when you are dizzy, driving could be a problem… But with a blog, the person can connect and learn right from their own living room! What a great idea! I was hooked!

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Two Cheetah brothers seen on Safari- South African inspiration at it’s best!

These are my ideas, and I’m sure that the more I do this, the better I will get at it, so be patient with me…

This is my mission statement: To provide information for free on the latest research, technology, treatment, and support for those living with dizziness, vertigo, balance problems, falls, facial paralysis, concussion, and inner ear disorders.

I want to include updates on meetings I attend. You see, the meetings I go to are for physicians, nurses, occupational therapists, speech language pathologists, physical therapists, and audiologists. I see this new blog as a bridge for the average guy or gal, to learn what is new in health care and how can they learn more to better their lives. I will share with you the latest and greatest in regards to treating the above symptoms, and links to the information.

I hope you find this information helpful, and hopeful. It is not meant to substitute for an evaluation by a doctor or physical therapist, so if you are having a problem, go see a reputable health care professional for guidance… Please feel free to give me your input, as this blog means nothing if it reaches no one… Also, let’s keep the message in focus, which is to help…

You can contact me, and I am interested in your comments.

Dr. Laura Wazen

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Listen. Listening is the most important step in understanding a patient’s concern. It is the most basic beginning, and in health care today, so often undervalued. It directs understanding, direction of testing, and formulation of a plan. It is the most important step in paving the road to treatment and recovery.

Learn. My role is not only to learn from my patients, but to guide them in how to learn from me, what they should do to take back their lives and create positive change.

Live. Life is a gift. The purpose of all treatment at Equinox Physical Therapy is to restore function, independence, and freedom to clients recovering from or living with an illness.

Vertigo

Dizziness

BPPV

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