Roughly 90 million Americans suffer from dizziness.
Dizziness or imbalance frequently has treatable underlying causes. Balance testing is designed for anyone with dizziness, vertigo, difficulty judging distance, people with an increased risk of falling and anyone who has fallen once in the past year.
The Balance Center at St. Luke’s Cornwall Hospital is designed to help individuals who experience vertigo, dizziness and other balance related problems. We perform diagnostic tests of the balance system that will help your physician identify the cause of your balance disorder and suggest the most effective treatment plan.
The St. Luke's Cornwall Hospital Balance Center uses a team approach to diagnose and treat your balance problems.
Join us as Kathleen Paoli, Audiologist, discusses common causes and treatments of inner ear balance issues and how The St. Luke's Cornwall Hospital Balance Center uses a team approach to diagnose and treat your balance problems.
Selected Podcast
Do You Suffer From Dizziness? We Are Here to Help!
Featured Speaker:
Kathleen Paoli, AuD
Kathleen Paoli, AuD received her bachelor’s degree in communication disorders from SUNY New Paltz and her Clinical Doctorate in audiology from the University of Texas at Austin. She has trained in balance centers in both Austin, TX and Syracuse, NY, and has specialized in balance testing at St. Luke's Cornwall Hospital for since 2015. She performs all of the testing at the SLCH Balance Center, collaborating with the vestibular physical therapist and supervising neurotologist. In addition to balance testing at SLCH, she is also an adjunct clinical audiology supervisor at SUNY New Paltz. Kathleen was born and raised in the Hudson Valley and is now raising her own family in the local community. Transcription:
Do You Suffer From Dizziness? We Are Here to Help!
Melanie Cole (Host): Nearly 90 million Americans suffer from dizziness. Dizziness or imbalance frequently has treatable, underlying causes. My guest today, is Kathleen Paoli. She’s an Audiologist at St. Luke’s Cornwall Hospital. Welcome to the show, Kathleen. How does our body maintain balance?
Kathleen Paoli (Guest): Well, we use three different systems to maintain balance. We use our visual system where our eyes bring in information about where we are in space. We use our proprioceptive system – the feeling of our feet on a hard surface, the pressure on our joints when we’re standing. We use our inner ear balance system, and there are some sensors in our inner ear that tell our brain where our head is oriented in space, it detects linear movement – those three systems combine to send information to your brain to understand how you’re oriented.
Melanie: So, then what happens when there is a balance disorder? What is that?
Kathleen: When you have a balance disorder, there’s a problem with your inner ear balance system. Either it’s malfunctioning in some way, or there’s a difference between your two ears or weakness in your balance system, so we do some testing here, at our center to detect that.
Melanie: What are some symptoms? People are always afraid of falling – certainly, the older population – what would you notice if there were some early red flags of a balance disorder.
Kathleen: Probably the most common type of balance disorder that affects the older population would be benign paroxysmal positional vertigo – which is kind of a mouthful, so we usually call it BPPV. That is an issue where the crystals that are lining your inner ear balance system – or your vestibular system, they can get knocked out of place and wind up where they’re to supposed to be. What we often hear is people say, “When I turn my head, I feel very dizzy for about 30 seconds – or a few seconds.” When I roll over in bed, I feel very dizzy when I look up. We do some testing to see if that’s what’s going on with them and we can refer accordingly.
Some other issues that can affect your balance system – sometimes a virus can affect your inner ear and make one side weaker than the other. That confuses your brain into thinking you’re spinning. Sometimes, things like Meniere’s disease can affect your hearing and your balance system. There can be an overabundance of the endolymph fluid that’s in your ear. Those are some of the more common balanced issues that we see.
Melanie: How do you diagnose them?
Kathleen: We have a number of tests here at our clinic. We have a computerized posturography system where we have patients maintain their balance with and without visual cues, with and without proprioceptive information. We have them stand on a cushion with their eyes closed using a harness system to prevent falls, and we see how well they can maintain their stance when visual and proprioceptive cues are removed, and we’re asking them to rely on just inner ear balance cues alone.
We also do some testing where we measure their ocular-motor function. The ocular-motor system is a balanced system – a lot of the wiring is the same, so there are a lot of reflexes involving your eyes. When you vestibular system detects motion, it will make your eyes do certain things to stabilize your vision. We do a lot of testing with their eye movements to see if that indicates that their vestibular system is working properly.
We also do some bi-thermal caloric irrigation. We will change the temperature of their inner ear by putting air into their ear, and that tricks their brain into thinking that their head is turning by moving the fluid in their inner ear with a convection current by changing the temperature.
Melanie: So, if you determine that someone has benign paroxysmal positional vertigo, or Meniere’s, or vestibular weakness, one of these -- what is the first-line of defense? Do you look to a type of physical therapy? Do you look to balance and dizziness training? Or, do you look to medicational intervention?
Kathleen: If we have a patient that tests positive for the Dix-Hallpike maneuver and it looks like they have benign paroxysmal positional vertigo, we’re very lucky that we have a very experienced vestibular physical therapist down the hall. Her name is Kitty, and she’s wonderful, and she does canalith repositioning therapy. She can actually do some maneuvers and exercises with the patients to help get the crystals out of the way so where they’re not causing a problem anymore. It’s usually pretty effective. Usually, within one or two treatments, patients are no longer experiencing symptoms.
Melanie: Isn’t this an interesting, burgeoning field. It really is because I’ve met so many more people that suffer from various forms of balance and dizziness disorders. What else is available, Kathleen, that can help with treatment? Are there some Antivert or things that people who get this on a regular basis can go on?
Kathleen: We would perform some diagnostic testing to figure out what’s going on and what’s causing the balance issue, and then we’ll refer back to the referring physician for treatment. Often, some options depending on what’s going on – for short-term relief, sometimes medication like Antivert, is prescribed. For vestibular weakness, sometimes the brain can learn how to compensate for the weakness of one vestibular system by learning how to rely on the other one, so physical therapy can be really helpful in teaching patients how to compensate. And the canalith repositioning maneuver can often remediate symptoms very quickly.
Melanie: In your experience, have you seen or noticed that people who suffer from these type of vestibular disorders that they go away or is it something they sort of having to keep an eye on for the rest of their lives?
Kathleen: It really depends on what’s going on. Some of them reoccur. Some of them periodically pop-up – Meniere’s disease is a combination of symptoms of hearing loss, dizziness, and roaring tinnitus that comes and goes. That may be something that they have to manage life-long. It really depends on what the cause of the balance issue is.
Melanie: Do you have some quick fixes as it were, or best advice – tips for people who do suffer from occasional dizziness? Is there anything they can do – if a bright light is what sets them off or if turning their head very quickly, what do you tell people when they ask you what they can do at home?
Kathleen: I would recommend to anybody who is experiencing dizziness to talk to their doctor about it and see if an Ear, Nose, and Throat doctor referral is in order. A lot of dizzy symptoms can be relieved by medical intervention or physical therapy, so it’s not worth suffering at home if you can find out the root cause of it and address it.
Melanie: And what would you like people to know about learning about their dizziness and balance disorders and maybe even working on some balance training so that if this happens, they’re not at as great a risk of falling?
Kathleen: I would encourage people to just look through their environment and be aware of tripping hazards in their home, make sure that there’s lighting in their hallways so that if they have to get up in the middle of the night they can see their pathway, remove area rugs, kind of make their home a little less hazardous to walk around in.
Melanie: Thank you, so much. And in summary, tell us about your team at St. Luke’s Cornwall Hospital.
Kathleen: We’re very fortunate here, we have a great team. As I said, I’m an audiologist. I do all of the testings here. We have a Neurotologist who supervises our clinic. She’s an Ear, Nose, and Throat doctor that specializes in the nerves of hearing. And then we also have a physical therapy office right down the hall with a vestibular specialist in physical therapy. We all work together very nicely, and I think it’s a great team to get some really good results for patients.
Melanie: Thank you so much, Kathleen, for being with us today, and for offering such great information. This is Doc Talk, presented by St. Luke’s Cornwall Hospital. For more information, please visit StLukesCornwallHospital.org, that’s StLukesCornwallHospital.org. This is Melanie Cole. Thanks, for tuning in.
Do You Suffer From Dizziness? We Are Here to Help!
Melanie Cole (Host): Nearly 90 million Americans suffer from dizziness. Dizziness or imbalance frequently has treatable, underlying causes. My guest today, is Kathleen Paoli. She’s an Audiologist at St. Luke’s Cornwall Hospital. Welcome to the show, Kathleen. How does our body maintain balance?
Kathleen Paoli (Guest): Well, we use three different systems to maintain balance. We use our visual system where our eyes bring in information about where we are in space. We use our proprioceptive system – the feeling of our feet on a hard surface, the pressure on our joints when we’re standing. We use our inner ear balance system, and there are some sensors in our inner ear that tell our brain where our head is oriented in space, it detects linear movement – those three systems combine to send information to your brain to understand how you’re oriented.
Melanie: So, then what happens when there is a balance disorder? What is that?
Kathleen: When you have a balance disorder, there’s a problem with your inner ear balance system. Either it’s malfunctioning in some way, or there’s a difference between your two ears or weakness in your balance system, so we do some testing here, at our center to detect that.
Melanie: What are some symptoms? People are always afraid of falling – certainly, the older population – what would you notice if there were some early red flags of a balance disorder.
Kathleen: Probably the most common type of balance disorder that affects the older population would be benign paroxysmal positional vertigo – which is kind of a mouthful, so we usually call it BPPV. That is an issue where the crystals that are lining your inner ear balance system – or your vestibular system, they can get knocked out of place and wind up where they’re to supposed to be. What we often hear is people say, “When I turn my head, I feel very dizzy for about 30 seconds – or a few seconds.” When I roll over in bed, I feel very dizzy when I look up. We do some testing to see if that’s what’s going on with them and we can refer accordingly.
Some other issues that can affect your balance system – sometimes a virus can affect your inner ear and make one side weaker than the other. That confuses your brain into thinking you’re spinning. Sometimes, things like Meniere’s disease can affect your hearing and your balance system. There can be an overabundance of the endolymph fluid that’s in your ear. Those are some of the more common balanced issues that we see.
Melanie: How do you diagnose them?
Kathleen: We have a number of tests here at our clinic. We have a computerized posturography system where we have patients maintain their balance with and without visual cues, with and without proprioceptive information. We have them stand on a cushion with their eyes closed using a harness system to prevent falls, and we see how well they can maintain their stance when visual and proprioceptive cues are removed, and we’re asking them to rely on just inner ear balance cues alone.
We also do some testing where we measure their ocular-motor function. The ocular-motor system is a balanced system – a lot of the wiring is the same, so there are a lot of reflexes involving your eyes. When you vestibular system detects motion, it will make your eyes do certain things to stabilize your vision. We do a lot of testing with their eye movements to see if that indicates that their vestibular system is working properly.
We also do some bi-thermal caloric irrigation. We will change the temperature of their inner ear by putting air into their ear, and that tricks their brain into thinking that their head is turning by moving the fluid in their inner ear with a convection current by changing the temperature.
Melanie: So, if you determine that someone has benign paroxysmal positional vertigo, or Meniere’s, or vestibular weakness, one of these -- what is the first-line of defense? Do you look to a type of physical therapy? Do you look to balance and dizziness training? Or, do you look to medicational intervention?
Kathleen: If we have a patient that tests positive for the Dix-Hallpike maneuver and it looks like they have benign paroxysmal positional vertigo, we’re very lucky that we have a very experienced vestibular physical therapist down the hall. Her name is Kitty, and she’s wonderful, and she does canalith repositioning therapy. She can actually do some maneuvers and exercises with the patients to help get the crystals out of the way so where they’re not causing a problem anymore. It’s usually pretty effective. Usually, within one or two treatments, patients are no longer experiencing symptoms.
Melanie: Isn’t this an interesting, burgeoning field. It really is because I’ve met so many more people that suffer from various forms of balance and dizziness disorders. What else is available, Kathleen, that can help with treatment? Are there some Antivert or things that people who get this on a regular basis can go on?
Kathleen: We would perform some diagnostic testing to figure out what’s going on and what’s causing the balance issue, and then we’ll refer back to the referring physician for treatment. Often, some options depending on what’s going on – for short-term relief, sometimes medication like Antivert, is prescribed. For vestibular weakness, sometimes the brain can learn how to compensate for the weakness of one vestibular system by learning how to rely on the other one, so physical therapy can be really helpful in teaching patients how to compensate. And the canalith repositioning maneuver can often remediate symptoms very quickly.
Melanie: In your experience, have you seen or noticed that people who suffer from these type of vestibular disorders that they go away or is it something they sort of having to keep an eye on for the rest of their lives?
Kathleen: It really depends on what’s going on. Some of them reoccur. Some of them periodically pop-up – Meniere’s disease is a combination of symptoms of hearing loss, dizziness, and roaring tinnitus that comes and goes. That may be something that they have to manage life-long. It really depends on what the cause of the balance issue is.
Melanie: Do you have some quick fixes as it were, or best advice – tips for people who do suffer from occasional dizziness? Is there anything they can do – if a bright light is what sets them off or if turning their head very quickly, what do you tell people when they ask you what they can do at home?
Kathleen: I would recommend to anybody who is experiencing dizziness to talk to their doctor about it and see if an Ear, Nose, and Throat doctor referral is in order. A lot of dizzy symptoms can be relieved by medical intervention or physical therapy, so it’s not worth suffering at home if you can find out the root cause of it and address it.
Melanie: And what would you like people to know about learning about their dizziness and balance disorders and maybe even working on some balance training so that if this happens, they’re not at as great a risk of falling?
Kathleen: I would encourage people to just look through their environment and be aware of tripping hazards in their home, make sure that there’s lighting in their hallways so that if they have to get up in the middle of the night they can see their pathway, remove area rugs, kind of make their home a little less hazardous to walk around in.
Melanie: Thank you, so much. And in summary, tell us about your team at St. Luke’s Cornwall Hospital.
Kathleen: We’re very fortunate here, we have a great team. As I said, I’m an audiologist. I do all of the testings here. We have a Neurotologist who supervises our clinic. She’s an Ear, Nose, and Throat doctor that specializes in the nerves of hearing. And then we also have a physical therapy office right down the hall with a vestibular specialist in physical therapy. We all work together very nicely, and I think it’s a great team to get some really good results for patients.
Melanie: Thank you so much, Kathleen, for being with us today, and for offering such great information. This is Doc Talk, presented by St. Luke’s Cornwall Hospital. For more information, please visit StLukesCornwallHospital.org, that’s StLukesCornwallHospital.org. This is Melanie Cole. Thanks, for tuning in.