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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.

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.

Published in Blog

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!
Published in Blog
Thursday, 26 December 2013 00:00

New Ear Research

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

 

Anil Blog_4-_Laura_at_Polizter_2013

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. 

Anil- Blog_4_coffee_break  

Turkish coffee break- Politzer Society Meeting 2013, Turkey

 

 

 

Published in Blog

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.

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