IMPROVEMENT IN HEARING IN A 54 YEAR OLD MALE WITH A 20 YEAR HISTORY OF HEARING LOSS WITH A PROGRAM OF MULTIMODAL VESTIBULAR REHABILITATION
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1
Brain, Spine & Sport, United States
Background: A 54 year old male presented to a private clinic with a chief complaint of dizziness and imbalance/unsteadiness for the past 17 years. A previous diagnosis of Benign Paroxysmal Positional Vertigo (BPPV) was given. The patient described the hearing impairment as persistent for at least 20 years and was described as having difficulty interpreting speech with background noise and in localizing sound in the left ear.
Methods: Neurological examination revealed abnormal gait with a leftward list and a loss of right arm swing with dual tasking. Tandem gait testing revealed ataxia. Alternating hand movements revealed dysdiadochokinesis on the left with arms outstretched and elbows at the sides of the body. Vertical pursuits contained abnormal horizontal movements. Optokinetic testing (OPK) was slow to both the right and left. Weber’s test was normal. Rinne’s test was positive on the left. Patient had loss of hearing on the left with 128 Hz and 256 Hz tuning forks placed near the left ear. There was no perceived sound in the left ear during finger rubbing. Romberg’s position revealed abnormal sway patterns and instability. Further testing in Romberg's position revealed the following: when the head was placed in left cervical rotation (biasing left horizontal canal), left posterior canal and right anterior canal bias, the patient stabilized in Romberg’s position. With the patient’s head in the bias of right posterior canal, left anterior canal and right horizontal canal, the patient destabilized in Romberg’s position. Computerized Dynamic Posturography (CDP) produced a fall with the eyes closed on a perturbed surface. Saccodometry of 100 saccades revealed hypometria bilaterally with leftward saccades worse. Velocity of saccades were slower to the left. A program of vestibular rehabilitation was prescribed and included passive and active canal stimulations, balance exercises, gaze stabilizing on firm and perturbed surfaces, tandem gait and stance exercises, and repositioning maneuvers biasing canals that revealed abnormality in Romberg’s and hearing testing. Spinal and extremity manipulative therapy as well as neuromuscular exercises to improve proprioception and balance were included.
Results: Initial treatment included a repositioning maneuver to the involved vestibular canals. A pattern of right anterior and left posterior (RALP) head position bias allowed the patient to hear 128 Hz, 256 Hz and finger rubbing in the left ear. A pattern of left anterior and right posterior (LARP) canal bias worsened the patient’s hearing; the repositioning maneuver that worsened hearing tests was chosen for initial treatment. One treatment and subsequent treatments following the same protocol allowed the patient to improve his hearing in his left ear. Patient reported improved hearing with repeated treatments where 128 hz, 256 hz and finger rubbing could be heard out of the left ear. Saccadometry improved with resolution of hypometria bilaterally. The patient did not fall with eyes closed on a perturbed surface with CAPS testing.
Conclusion: this author recommends further investigation into the use of repositioning maneuvers without BPPV to improve symptoms of dizziness, imbalance and hearing loss.
Keywords:
Dizziness,
Vertigo,
Ataxia,
Incoordination,
Hearing Loss,
Repositioning maneuver,
Neurorehabilitation,
Vestibular Rehabilitation,
saccadometry,
computerized dynamic posturography,
Romberg test,
Tandem gait,
Gaze stabilization,
Eye Movements,
benign paroxysmal positional vertigo
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Schiller
D
(2018). IMPROVEMENT IN HEARING IN A 54 YEAR OLD MALE WITH A 20 YEAR HISTORY OF HEARING LOSS WITH A PROGRAM OF MULTIMODAL VESTIBULAR REHABILITATION.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00107
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Received:
02 Apr 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. David Schiller, Brain, Spine & Sport, Avon, Connecticut, 06001, United States, drschiller@comcast.net