Management of a child with hyperacusis and motion sickness with patient specific neurorehabilitation treatments
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1
Life University, United States
Background:
A 7-year-old girl presented with hyperacusis and motion sickness that she had been experiencing for a few months. The hyperacusis was reported worse on the right and was severe to the point of necessitating wearing noise reduction headphones while attending her music class in school, sitting in restaurants and while a vacuum was running. She reported experiencing stomach pain concomitant with the painful noises. The motion sickness prevented her from participating in cheerleading and experienced nausea and vomiting after car rides. Her mother reported that the family had to make frequent stops whenever they drove in the car, so the patient could get out of the car and sit still for a while. The child would become emotionally upset and cry during these stops. She did not tolerate up and down movements such as elevators and was averse to spinning, like on a carousel. She had a history of similar complaints when she was 4 years old. Evaluation by her pediatric otolaryngologist at that time reported everything as normal and said the symptoms would be self-limiting. After a self-directed adoption of a vegetarian diet, the symptoms decreased. Eventually the she added meat back into her diet. A few months ago her symptoms re-emerged. Attempting a vegetarian diet at this point did not relieve her symptoms. The child was born by emergency C-section after a placental rupture. At the time of birth her APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score was 6/7 and she was hospitalized for 6 days. She was released with no apparent deficits. The child has been under maintenance chiropractic care since birth and is non-vaccinated.
Methods:
Examination revealed that the patient had an accommodation spasm with left esotropia worse than right. Pursuit testing revealed saccadic intrusions in both horizontal and vertical directions. Saccades were hypermetric to the left and hypometric to the right. Vertical saccades were also dysmetric. Direct light reflex showed an inability to hold pupillary constriction on the left. Left eye convergence failed at 3 inches. There was an alternating nystagmus observed on ophthalmic exam. Balance was unstable in tandem stance with her left foot in the posterior position. A right palatal paresis was observed. A 512 tuning fork held in front of her left ear caused pain and an aversive response. Vibration with a 128 tuning fork held on the tragus and mastoid bilaterally elicited no pain. The hyperacusis increased on the right and left by activation of the right middle semicircular canal with a rightward Halmagyi head thrust and improved with a leftward Halmagyi head thrust. The vestibular ocular reflex (VOR) produced nystagmus bilaterally with the leftward head rotation worse than right. Finger to thumb tapping test proved slower on the left. Alternating palms up/palms down testing was dysmetric on the left. Finger-to-nose testing was less accurate with the left hand. Treatment included vestibular activation with leftward rotations in a chair. Divergence eye exercises were also employed with utricular stimulation in a posterior direction. She performed gaze stabilization exercises as well as microsaccades to small targets in a vector that was up and to the right, followed by a pursuit in a downward and left direction. Passive complex motion in a figure eight pattern was performed with the upper and lower extremities in counter-phase. At home exercises were to be performed three times per day to promote neuroplasticity.
Results:
After the first visit there was stability of gaze fixation during VOR reflex testing. She reported no pain with the tuning fork held in front of the left or right ear. Horizontal pursuits were smoother with fewer saccadic intrusions. She was able to attend music class the next day and for the first time that year she did not have to wear headphones nor sit in the very back of the class. The noise from the piano and drums, which created such ear pain and nausea for her previously, were no longer an issue. After five visits over the course of a month, she continued to be pain free from the tuning fork or other noises in her ears bilaterally. She attended all music classes and other noisy events without ear pain or nausea. Her pursuits continued to be smooth and accurate horizontally and her vertical pursuits were improved, but a saccadic intrusion remained in the downward direction. Saccades were accurate in all directions. Finger-to-thumb tapping, alternating palms up/palms down, and finger-to-nose testing aberrancies were all resolved. The left esotropia persisted as did continued issues with motion sickness in the large “bouncy” family truck during drives longer than a couple of hours. The previous motion sickness was no longer an issue in the family car for daily trip around town and did not require stops.
Conclusion:
This case highlights the use of patient specific therapies and exercises to improve the integration of central vestibular and auditory deficits. Additional studies in the use of neurorehabilitation for auditory and vestibular disorders are recommended.
Keywords:
vestibulo ocular,
Hyperacusis,
neurological rehabilitation,
Chiropractic,
Motion Sickness
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Esposito
SE and
Mullin Elkins
L
(2016). Management of a child with hyperacusis and motion sickness with patient specific neurorehabilitation treatments.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00038
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Received:
31 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com