March 2023- Rotary Chair

Hi Everyone, This months session was a little shorter, but in my opinion more thought provoking. How do you use rotary chair? Do you conduct this test on everyone? How specific are you about mental tasking? Do these articles raise questions about your clinic practice and how it may change, or do they raise questions about all the variables we as clinicians see day in and day out and how they might alter these outcomes? I for one felt like there was so much to these articles that wasn't written, so lets discuss!

February 2023: Vestibular Migraines

 Hi everyone! 

There are so many more of you this month than last, so it's encouraged me to change up the model a little bit more to really listen to your feedback and increase the sense of community and collaboration. 

This month's journal club was focused on Vestibular Migraines and included information about epidemiology, (very broad) pathogenesis, clinical features, differential diagnosis, testing and management. 

As I mentioned in the email, my Google literacy is....emerging and I am working on one screen (soon to change). I wasn't able to admit everyone and present at the same time, or see questions as they appeared in the chat, and they weren't addressed at the time- which I apologize. I figured in an effort to increase conversation, I will post the questions here with my responses, however I would love to have comments on this post with your thoughts/feelings/ input for not only these questions but vestibular migraines in general. Should this blog format prove to be ok but not ideal, I am working on a website that can hopefully get the ball rolling quite a bit. I have added all three meetings so far and will continue to update the google drive with slides, resources and articles and continue the email chain. Linked in this post is the recording for easier access, and I am working on a way to link the articles featured as well. 

Here are the typed questions that were missed during the live session:

1- from L.P.: Is there a questionnaire that can be used to better rule in/rule out other disorders from vestibular migraine? I believe so. Attached are two articles about using the DHI to better characterize/identify vestibular migraine (Chari et al) and another about how DHI results may vary among patients with different types of migraines (Emer et al). These might help give us better clues about patients with vestibular migraine versus something else or patients with a history of migraine and dizziness but maybe the type of migraine they have is unrelated/ less characteristic of vestibular migraine. I think this could be an interesting revisited topic down the line.

2- also from L.P.: Is there a cut off age where vestibular rehabilitation may become less effective in the management of vestibular migraine?

From my experience working with geriatric populations, particular with vestibular and subclinical balance disorders I don't believe there is a cut off age per say, but in the Jacobson vestibular textbook "Balance Function Assessment and Management", there is a fantastic chapter about managing vestibular problems in older patients and it states that vestibular rehab doesn't become less effective, it just may take more sessions or have slower progress than a younger individual. Specific age cutoff is unknown to me but I can keep looking.

3- from S.R.: Is vertical nystagmus that may be seen in positional testing resolved with fixation? In my experience yes and no- it depends on if its from a central or peripheral origin. The home statement I use for central positional nystagmus/vertigo also comes from the Jacobson vestibular textbook pages 667-6709of the 3rd edition (It's truly my holy text and I nearly have read it cover to cover. I'd be starstruck to be frank) "the elicited nystagmus is typically vertical. In the absence of other findings the CPN is thought to be benign. In other individuals, the CPN may be seen in conjunction with up beating or down beating spontaneous nystagmus while seated... a more common form of CPV is migrainous vertigo and positional nystagmus. Spontaneous, positional or a combination of spontaneous and positional nystagmus can be seen during an acute migraine with associated symptoms of dizziness. In these cases, the nystagmus can be vertical, horizontal or torsional with different positional tests"

4- Also from S.R.: Is there a dominating theory that vestibular migraines may be the cause of motion sickness that persists into adulthood?

I am completely unaware of the answer to this, but am happy to dig in a bit and report back.

5- from M.K.- asked a clarifying question regarding hearing loss associated with vestibular migraines and Meniere's disease.

In Meniere's disease it is typically starting as a low frequency SNHL with progression into the high frequencies (it often flattens out) and crappy word recognition. Hearing loss tends to quickly surpass the mild mark. The hearing loss is typically in the affected ear, and if it progresses to bilateral Meniere's disease the hearing loss will follow suit. For vestibular migraines, the articles I reviewed suggested that any fluctuations in hearing loss are transient and largely subjective (difficult to capture) and are normal sloping to relatively mild SNHL bilaterally. Hearing loss is less likely to be as progressive and more likely to maintain symmetry.

6- Last, B.C. made a fantastic recommendation regarding seeking a diagnosis and I quoted her comment here: "Several years ago I worked with 2 Neuro-Otologists, one was very involved in Vestibular Migraine diagnosis management, while the other physician felt strongly that vestibular migraine was not a true condition. I think for patients it is important to get more than one medical opinion if they are suffering from vestibular disturbances that may be migraine related".

Here is the link to the shared google drive. You're able to access it if you're in the email chain, so if you are not/can't access it reach out to me at kryanaud@gmail.com and let me know!
: https://drive.google.com/drive/folders/1OYNQf6vrbgo6DP4SNN4VEawr-aIny0Jx?usp=share_link

Hope you enjoy this month! Can't wait to hear from you.

December 2022- Advanced Vestibular Evoked Myogenic Potentials

 https://drive.google.com/drive/folders/1_Y5ISYGvl2Df0cB3DUgF_8tOV2oWukcl?usp=share_link

Hi again everyone

Here is a link to the google drive for the December 2022 Journal club articles and slides above and the recording.

Next Month, January 4, 2023 we will go over clinical signs of vestibular migraine by suggestion of a participant! If you want to provide some input drop a comment or email me!

Kaitie

November 2022- Case History and Clinical Considerations

 Here is a posting of month one with a link to the unlisted (only people with the link see the video) youtube video. I figured that the recordings will be more easily accessed there and will be more easily available for people who don't have access to the google drive, or it bewilders them (like it does me). 

I made a faux pas and the slides didn't advance along with the video so here are the time stamps for that

Timestamps:

1- Intro 0:00-1:143

2- Housekeeping 1:44-3:44

3- About Me 3:44-4:55

4- Agenda 4:56-5:18

5- Terms and Conditions 5:19-5:52

6- Highlights 5:53-6:51

7- Non Vertiginous Complaints 6:52-8:39

8- Vertiginous Complaints 8:40-10:26

9- What aren't you asking? 10:27-14:05

10- Case Study 1- 14:10-18:02

11- Case Study 2 18:04-19:32

12- Case Study 3 19:33-21:18

13- vHIT for Case Study 3 21:19-22:03

14- What are you asking? 22:04-24:10

15- The art of case history 24:11-26:22

16- My experience 26:23-27:04

17: Case Study 4 27:05-30:07

18- Who is a candidate? 30:08-30:29

19- Who is a candidate- schools of thought 30:30- 32:52

20- Not a candidate 32:53- 34:49

21- What else goes into it? 34:50-36:46

22- Case Study 5 36:54- 39:00

23-24- Patient considerations/ The Elderly dizzy  patient 39:02-39:42

25- The Elderly Dizzy Patient 39:43- 41:42

26- Effects of Aging 41:45- 42:39 

27- Fear of Falling 42:40- 43:43

28- Case History Considerations for the Elderly 43:44-45:06

29- Other Groups that May Need Special Consideration 45:07-48:17

30- Other considerations? 48:28-50:00

31- Next Month 50:01-50:50

32- Recording Disclosure 50:51-51:01

33- Questions? Contact 51:02

and here is a link to the slides as well https://docs.google.com/presentation/d/1YMFb6jxRlyaeVFpFiNlDSeb05PyV4yzf/edit?usp=share_link&ouid=108777802488348622856&rtpof=true&sd=true

Welcome!

 Hi Everyone!

I am trying out a new format from the group emails and Google Drive to try to increase access and collaboration, which was the original intent behind the Journal Club. 

I will still be sending slides and articles around in email, but will post the recordings here as well as in the google drive to make it easier for everyone. 

Please share the link with any others interested in Vestibular sciences and let me know if you have any suggestions!

Kaitie