Connoisseurs of Books (Knowledge is Power), by Nikolay Bogdanov-Belsky, 1920
My physical therapy practice in Sarasota, Florida, is devoted to helping people with balance and inner ear problems. So you may be wondering why I am writing about visual problems The reason is: vision is extremely important in maintaining good balance! We use our vision to understand where we are in space, and how to negotiate obstacles in our environment. As adults, we have an idea of what good vision is, and we are likely to notice if our vision changes. But what if the person we are talking about is a small child, maybe even an infant who may not be able to communicate or recognize that he/she is having a visual problem? This child, in addition to a visual problem, could also be experiencing a balance problem, because we know that good vision and good balance are closely connected.
I was lucky to be talking about this problem with my friend and associate Dr. Mohamad S. Jaafar. Dr. Jaafar is Professor of Ophthalmology and Pediatrics at the George Washington University, and Chief of the Division of Ophthalmology at the Children’s National Health System, Washington, DC. He is passionate about training young doctors to be experts in his field and is the Past-Director of Washington’s Pediatric Ophthalmology Fellowship Program, which is the oldest, largest, and most renowned such program in the world.
Dr. Jaafar and I want to help parents recognize visual problems in their children, so that they know when to seek help. Bear in mind that there is an association of eye diseases in some children who have hearing loss (such as retinal dystrophy, cataract and misalignment of the eyes). Dr. Jaafar was kind enough to provide this top 5 list, so that parents know what to look for if they suspect their child may have a visual problem.
TOP 5 Signs of Visual Problems in Children
1. Bumping into things or acting clumsy.
2. Always sitting close to the TV or holding books and I-pads too close to their face.
3. Crossed or wandering eyes.
4. Tilting or turning the head, or assuming a chin-up or chin-down posture (ocular torticollis).
5. Disliking having one eye covered but not the other (may indicate a “lazy eye” – amblyopia).
If your child is showing these signs, was born prematurely, has multiple health problems or a family history of eye diseases in childhood, it is a good idea to consult an eye doctor who is experienced in treating infants/children. Please remember, a TOP 5 list is not all inclusive. If you have questions about your child’s vision, go and see a specialist or ask your Pediatrician. Dr. Jaafar suggests that you could find a qualified doctor in your area by going to the following website: https://aaosso.aapos.org/ebusaapos/FindanEyeMD
The New Labyrinth with Black Holes by George Saru, 1996.
Last year I wrote an article for my blog about anxiety and inner ear problems based on the research by Dr. P. Ashley Wackym. It turns out that it has been one of my most frequently visited blog posts! Last October 2015, I saw Dr. Wackym again when we were both attending the 7th International Symposium on Meniere’s Disease and Inner Ear Problems in Rome, Italy. During our discussions, I learned of a recent research article of his that was published in the ENT Journal (Ear, Nose and Throat) that studied people with a type of inner ear problem called Superior Semi Circular Canal Dehiscence (SSCD). This is a condition where the bone between the inner ear system and the brain erodes causing symptoms of imbalance, headache, dizziness, tinnitus, cognitive dysfunction, nausea, subjective hearing loss, visual disturbance, aural fullness, objective hearing loss, hyperacusis, and vomiting.
Although I don’t usually post scientific articles on my blog because I want the information to be easy for the average lay person to understand, for those of you with SSCD, you may find the information interesting… If so, feel free to read Dr. Wackym’s research paper!
BPPV (Benign Paroxysmal Positional Vertigo) is the most common type of inner ear problem, comprising approximately 25% of all inner ear problems. It is caused when crystals in the ear that are supposed to sit on top of the nerve fibers in a jelly like matrix, become loose and start floating in the semi-circular canals of the ear. When this happens, the person can experience a spinning sensation (vertigo) that lasts for seconds and is triggered by changes in head or body position. For instance, it happens when getting in/out of bed, bending over, or tipping your head back.
In answer to the question, “Can people have BPPV in both ears?” the answer is YES. About 40% of people can have it in both ears at the same time. The good news is that if the condition does not go away on its own, it can be treated with maneuvers to guide the crystals back into the part of the ear where they belong.
If you think you have BPPV, I encourage you to find a qualified doctor or physical therapist, who can test to see if BPPV is your problem, and if it is in one ear or both ears. The proper testing leads to the proper treatment, and to the proper cure…
Painting entitled, A Serious Question, by Sergey Solomko
In this self-portrait of Vincent van Gogh, we can look at it and see that he has his right ear bandaged, and without even knowing him, we can surmise that something is wrong with his ear. He has a bandage on his outer ear, and looking at the painting, one can has some empathy for him. But when a person has an inner ear disorder, there is no bandage one can wear that alerts others that we are having a problem. I think it is fair to say that Inner Ear Disorders are “invisible” to others. What do I mean by that? Well, if you had a broken arm, every one would see the cast on your arm, and they could relate to that. I you had a cold, or the flu, even without a bandage, others can understand that because they know what it feels like themselves to have this type of illness. But with inner ear disorders, for those friends and family members who have never had an inner ear balance problem, it can be hard to understand what if feels like to have vertigo, dizziness, or imbalance. Some patients tell me that they feel as though their family doesn’t understand their problem, because they don’t “look” sick.
For the person with the inner ear problem, this can add to their stress and sometimes cause added depression. Hang in there!!! If it is possible (and you want them to), having a spouse, grown child, or your best friend come with you to your doctor or physical therapy sessions can help that person better understand your condition, and in so doing, be better able to offer you the empathy, support, and understanding you could use. I have also had physical therapy patients in Sarasota, Florida who did not have this support network. They may live alone, or have no children or friends near by. This is not uncommon here, where many people come only for the winter months to escape the cold northern winters. Some of these individuals decided to take the bull by the horns, and go and see a psychologist who helped them learn better coping skills that they could apply on their own. I really admired these patients and their commitment to do whatever it takes to help themselves learn ways to better deal with their “invisible disease”. Whatever the case, don’t be afraid to ask those around you for help. We all need a helping hand at some point in our lives...
Painting by Vincent van Gogh, Self Portrait with Bandaged Ear, 1889
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.
Turkish coffee break- Politzer Society Meeting 2013, Turkey