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Vol. 10, No. 2, Spring 1993
A Word To
Vestibular Citizens
By Jane Mahoney
If you have encountered the disabling
effects of vertigo or are close to someone
who has an inner ear problem, then you're
well aware of the need for extended
research in vestibular medicine.
It's estimated that more than 76 million
Americans living today will suffer from
inner ear problems sometime during their
lives. Many will find relief. Without the
benefit of advanced research, however,
many will encounter conflicting diagnoses,
discouraging setbacks, and insufficient
therapies -- perhaps for a lifetime. If only
more were known!
As a vestibular citizen, your call for
continued research can be heard. Some of
the best vestibular research in the U.S. is
funded by the National Institutes of
Health (NIH). The NIH is funded by
Congress. And Congresspersons, whose
votes establish NIH priorities, listen to
their constituents. You can help educate
your Senator or Representative on
vestibular concerns through a simple note
or phone call.
Because people with vestibular disorders
can appear healthy despite significant
disability, the serious nature of vestibular
disorders can be underestimated.
Education is a vital tool for building
public awareness. Advocacy brings results:
cancer research, heart research, and AIDS
research have all benefitted from strong
constituent response.
Currently, the NIH funds research on
balance and dizziness through its institutes
of aging (NIA), deafness and other
communication disorders (NIDCD),
neurological disorders and stroke
(NINDS), and center for research
resources (NCRR). Research efforts have
met with success. Still, much remains to be
learned about cause, diagnosis, surgical
techniques, treatment, and rehabilitation
of inner ear problems. Despite a critical
need for more knowledge, research on
balance and dizziness remains a minor
funding priority with the NIH.
When the NIH pays for research at
hospital and university centers, new
discoveries are made. For instance, the
Johns Hopkins Center in Hearing and
Balance, in Baltimore, is a major NIH site
for research. Focusing on diagnostic and
treatment strategies, the center has
introduced innovative rehabilitation
programs. Another example is the UCLA
Balance and Dizziness Research Program,
in Los Angeles, which uses NIH support
to integrate the disciplines of neurology,
otolaryngology, and ophthalmology. This
center specializes in the diagnosis and
treatment of disorders of the inner ear
and of eye movement.
In its brochure, "Dizziness: Hope Through
Research," the NIH notes the importance
of vestibular research: "With support,
scientists are searching for better ways to
diagnose and treat dizziness. . . . These
studies, along with basic research on how
the ear, brain, and nerves work, hold the
best hope for relief for dizziness sufferers."
If you write or call your Senator or
Representative advocating more NIH
funding for research, be short and concise.
Congress should know that funding is
needed for both basic science research
(discovering how the inner ear works) and
for clinical research (developing improved
treatment strategies). The following
statistics, issued by the NIH and included
in the VEDA fact sheet, "Did You
Know?" might help you present your
argument:
Over 42% of the American population
aged 17 and older have complained of
vertigo or dizziness.
Balance-related falls account for more
than half the accidental deaths in the
elderly.
The cost of medical care for patients with
balance and dizziness disorders exceeds $1
billion a year in the U.S. alone.
(If you are not a U.S. citizen, you may
learn about your country's vestibular
research by writing or calling your local
government or library.)
In the past 10 years, the diagnosis and
treatment of vestibular disorders has
improved dramatically. More research can
help thousands more lead a vertigo-free
life.
________________________
NIH RESOURCES
AVAILABLE
The following information is available
free-of-charge from the National
Institute of Health NIDCD
Clearinghouse:
"Dizziness: Hope Through Research"
(brochure)
"Balance Disorders Organizational
Resources" (fact sheet)
"Acoustic Neuroma" (fact sheet)
"Because You Asked About Meniere's
Disease" (fact sheet)
CHID (computerized bibliographic
database). Contains references to
health information and health education
resources.
For more information write NIDCD
Clearinghouse, PO Box 37777,
Washington, D.C., 20013 or call (800)
241-1044 (voice) or (800) 241-1055
(TDD/TT).
NEWS AND REVIEWS
By Susan L. Engel-Arieli, M.D.
Below are summaries of articles that
appeared in recent medical and
professional journals:
1. Best Shoes for Balance? -- People such
as the elderly who are susceptible to
balance problems have generally been
advised or have chosen to wear athletic
shoes with thick soft soles. A recent study
indicates that a hard stiff sole may be
more able to transmit position information
to the foot. Such a sole is less
comfortable, but a group of researchers
says that people who have fallen or who
have balance problems should avoid shoes
with thick floppy soles and that walking
barefoot may also be less safe. See
Robbins, S., et al., "Shoe Sole Thickness
and Hardness Influence Balance. . .,"
Journal of the American Geriatrics Society,
40, November 1992, pages 1089-1094.
2. Rehabilitation Therapy for Balance
Disorders -- Dr. Konrad, et al., say that
research suggests that rehabilitation
therapy should be specifically designed for
each person with vestibular or balance
problems. They also indicate that to be
most effective the therapy should start
soon after the problems have begun and
that some medications to treat the
disorder may actually reduce recovery.
Patients with benign paroxysmal positional
vertigo or one-sided vestibular disorders
with no brain involvement seem to
respond best to therapy. Patients with
Meniere's disease generally may not
respond as well, and those with a central
component (brain involvement) may
respond more slowly.
See Konrad, H.R., et al., "Rehabilitation
Therapy for Patients. . .," Otolaryngology --
Head and Neck Surgery, 107(1) July 1992,
pages 105-108.
3. Treatment for Chronic Neck Pain After
Whiplash? -- Whiplash injury, usually
caused by sudden movements from a car
accident, can produce chronic vertigo or
dizziness and pain and/or reduced
mobility in the neck, upper back, and
shoulders.
A recent Swedish study indicated that in a
limited study of 40 patients, the majority
of patients had relieved or much-relieved
pain after subcutaneous injections of
sterile water in the affected area. The
report says patients experienced an initial
stinging pain for about 30 seconds and
that most required two to four treatments
over about six months.
The authors state they have been
successful with hundreds of patients, but
not everyone has continued with
diminished pain. No specific mention was
made of vertigo. See Byrn, C., et al.,
"Subcutaneous Sterile Water Injections. .
.," The Lancet, Vol. 341, No. 8843, Feb. 20,
1993, pages 448-452.
4. Safer Test for Studying Blood Vessels --
Researchers at the House Ear Clinic, Los
Angeles, report that, based on a review of
25 patients, magnetic resonance
angiography (MRA) is a useful procedure
for evaluating major blood vessels.
(Abnormal blood vessels can cause
vertigo.)
MRA reduces the risks of angiography
(another test often used to study blood
vessels), which include stroke, kidney
damage, radiation damage, blood-vessel
injury, etc. See Rodgers, et al., "MRA:
Analysis of Vascular Lesions . . .,"
American Journal of Otology, 14(1),
January 1993, pages 56-62.
5. Acupuncture and Tinnitus -- Doctors
from Sweden recently used acupuncture to
treat patients with severe and continuous
tinnitus. Statistical analysis did not show
any significant improvement. See Nilsson,
et al., "Acupuncture for Tinnitus. . .,"
Scandinavian Audiology, 21(4), 1992, pages
245-251.
6. Vertigo in Children -- A medical paper
published in France states that the main
difference between childhood and adult
vertigo is that evaluation poses special
challenges in children depending on their
age. Vestibular disorders are not
distributed in the same way among adults
and children, and often the diagnosis in
children cannot be considered final, the
paper says. The authors suggest more
study is needed. See Morgan, A., "Vertigo
in Children," Annales de Pediatrie, 39(8),
October 1992, pages 519-522.
7. Testing for Recurrent Vertigo with
Syncope -- Recurrent vertigo associated
with syncope (fainting) or near syncope
with no apparent cause is perplexing.
Physicians at the Medical College of Ohio
have studied patients in this category,
using an upright tilt-table test. If patients
had a positive test result, indicating some
type of vasovagal (blood vessel - vagus
nerve) problem, they were treated with
drugs such as scopolamine. Each tilt-
positive patient on treatment eventually
became tilt-negative, with no more vertigo
or syncope. See Grubb, B.P., et al., "Head-
Upright Tilt Table Testing. . .,"
Otolaryngology -- Head and Neck Surgery,"
107(4), October 1992, pages 570-6.
Here are summaries of articles appearing
in non-technical publications:
1. Nail Polish and Dizziness? -- Toluene, a
solvent in nail polish, can penetrate nails
and enter the blood. It may be the cause
of occasional bouts of dizziness and
nausea. Reportedly, Revlon, Almay, OPI,
and Matrix have stopped using toluene.
(You may want to check the ingredients
on your nail polish.) A similar-sounding
compound, toluenesulfonamide/epoxy
resin, apparently does not pose any
threats, a recent article said. See "Could
Nail Polish Make You Dizzy?" Woman's
Day, Feb. 2, 1993, page 20.
2. Silence the Buzzing -- Tinnitus (ringing
or noise in the ear) is increased by muscle
spasms, stress, and tension. According to
a recent article, up to 80 percent of
tinnitus patients using biofeedback report
some reduction in buzzing, while about 20
percent report total elimination. See
Stocker, S., ". . . Silence the Buzzing in
Your Ears," Prevention, February 1993,
page 144.
3. Chronic Headaches -- Researchers at
Rush-Presbyterian St. Luke's Hospital in
Chicago state that some chronic headaches
that don't respond to other treatment can
be soothed by fluoxetine, an
antidepressant. See Health Confidential,
March 1993, page 2.
4. Over 'n' Out -- A recent article discusses
the malady of motion sickness, says that
about 26 million Americans suffer from it,
and gives tips for avoiding it. The tips are
simple but hit home: avoid situations
likely to produce motion sickness; ride in
the front of a car or bus; if possible, drive
the car or bus; take motion sickness
medicine before you start activity that may
produce motion sickness; try to sleep
during the activity; avoid alcohol. The
article includes an interview with Dr.
Timothy Hain of Northwestern Memorial
Hospital in Chicago who discusses the
causes and treatments of motion sickness.
Also, information is provided on reducing
motion sickness in children. See Vettel, P.,
"Over 'n' Out," The Chicago Tribune,
Section 17N, Jan. 10, 1993, pages 1 and 5.
5. Ataxia and Its Implications -- In
response to questions, Dr. S.H. Subramony
of the University of Mississippi Medical
Center in Jackson states that smoking
sometimes aggravates ataxia, a balance
disorder, but it is not known if caffeine
worsens it. However, he states that
caffeine has many effects on nervous
system enzymes and pathways. Dr.
Subramony adds that fatigue is common in
ataxia and other neurological disorders.
The exact reason for the fatigue is not
known but does not seem to lie in the
muscles. See "Dr. Subramony Explains
Balance," Generations, Vol. 20, No. 4,
December 1992, pages 12-13.
Author's Note: Please note that neither Dr.
Engel-Arieli or VEDA can recommend or
be responsible for an individual's reaction
to a particular treatment. These reviews
are not intended as a substitute for
professional health care by your own
physician. Please do not begin any
treatment without first checking with your
physician.
NEW MATERIALS
AVAILABLE
FROM VEDA
VEDA recently added the following items:
B-3: Stories and Strategies: Coping With
Vestibular Disorders, 61 pages, personal
stories written by VEDA members, $6. B-
3 was in the final editing stages as this
newsletter went to press. It should be
available in late May.
"L-0: Books," 5 pages, a selected
bibliography (list) of technical book-length
works on vestibular disorders. This list fills
a gap in our L-1, L-2, L-3 bibliographies,
which list articles but not books. This list
is free to members. To receive L-0, please
send a self-addressed long envelope with
29 cents postage.
"L-3: Bibliography 92," 35 pages, a
selected, annotated list of recent technical
(peer-review) articles on vestibular
disorders. This is the third in VEDA's
series of annual bibliographies. The price
is $10.
THANK YOU
We thank all of
the following for
their contributions
to VEDA through
April 5:
Associates ($100 to $499): Schultz Foundation Inc.,
FL; Steven Smith, MI; Dr. Gerald Labriola, CT; Cindy Goral,
CA; Sue Parks, WA; Dr. Jeffrey Kramer & Dr. Jordan Waxman,
IL; Edwin D. Martin, FL; Naomi Lederer, NY; Mr. & Mrs. W.C.
Cooke Jr., VA; Dom Celentano, NJ; Dr. Sidney Busis, PA;
Norman Griner, NY.
Contributors ($10 to $99):
ALASKA: Donald Abel, John Loomis, Lawrence Palmer.
ARIZONA: Gail Walker, Marjorie Rolfe, Charles Hartwell,
Doris & Fred Guilford, Norma Raya.
ARKANSAS: Margaret McCrady.
CALIFORNIA: Patricia Coats, Karolyn Zebarth, Susan Atchley,
Rachel Brokaw, Joann Caouette, Therese Mifek, Jon Crawford,
Faye Taylor, Shirley Englander, Jeanette Brown, Mary Minando,
Betty Hwang, Patricia Spinosa, Lillian Kuhn, John Pino, Jack
Goodman, Beverly Peterson, Karolyn Zebarth, Alex Sherman,
Mary Sanchez, Rachel Frese, Jon Crawford, Floyd Paul, Thomas
Scott, Charles Kuhns, Lee Beckom, Ruth Corson, Mario Persico,
Geraldine White, Arvind Sakliker, Bonita Runge, Carol Labadie,
Jerrene Ricci, Marie Ralph, Vee Robinson, Myron Roth,
Suzanne Cresswell PT, Roger Webster, Anne Phillips, Anne
Walston, Mary Walker, Mary Lou Wood, Marguerite Brinegar,
Rita Manuelli, Lee Law.
COLORADO: Vivian Saltus, Mary & Don Edgington, Lori
Kaplan, James Gliozzi, Marilyn Girouard, Michael Derr, Kim
Buchwald, Ralph Oscarson, Abraham Shapiro, Lydia Coulter,
Paul & Myrna Sunberg, Don R. Anderson.
CONNECTICUT: Dorothy Coughlin, Dr. John Kveton, Kenneth
Brown.
FLORIDA: Virginia Brown, Lillian Archer, Gloria Massry.
Tess Cole, Lucille Anderson, Phyllis Cohen-Hartzman, Joan
Kostenbader, Pauline Edgett, Jeremiah Daly, Daryl Chapin,
Catherine Beale, Tess Cole, Robert Lee, Brenda Danback, A.H.
Duvall, Abe Tannenbaum, Hannah Polansky, Patricia Kennedy,
Wilfred Starr, Lorraine Bridges, Kathryn Karpowicz, Mrs.
Winthrop Bancroft, Henry Chaffee, Phyllis Cohen-Hartzman,
Susan & Jeff Kaye.
GEORGIA: Louise Williams, Sally Foster, Rufus Jones, Patti
Hallowell, Kathy Gaines, Mrs. Eric Tiller, James McCloskey,
Elizabeth Spiegel.
IDAHO: Deborah Haveman, Mrs. Vernon Peterson, Grant
Ipsen.
ILLINOIS: Charlotte Palmer, Annette Koltveit, Ruth Fullerton,
Joseph Pompei, C.F. Moculeski, Thomas Casey, Mr. & Mrs.
Donald Anderson, Carl Lund, Margaret Berzin, Phyllis Johnson,
Mildred Walter, Elsie Ryan, David Lersch, Teresa Campana,
Richard Wasser, Gail Scully, Jesse Irick.
INDIANA: Paula Long, Grama Bhagavan, Louise Clark,
Mildred Ertz, Jill Moore, Arline Newman.
IOWA: Virginia Ryan, Dorothy Hatala, Barbara Clark.
KANSAS: Imogene Leard, Mr. & Mrs. Jack Warner, John Voss,
John Webb, John Peterson.
KENTUCKY: Helen Carson, Sharon Nieman, Mary Williams.
LOUISIANA: AnneMarie Maher, Phyllis Chatman.
MAINE: Carol Ripley, Linda Dowell, Mary Dyer.
MARYLAND: Shirley Friedman, Phyllis Zheutlin, Charlotte
Davey, Muriel Engel, Earl Marsh, Stanley Oliver.
MASSACHUSETTS: Virginia Strauss, Marie Leonard, Anna
Hendricks, Michael Impastato, Eleanor Stichweh, Francis Fay,
Beulah Morrison, M. Fatima Martins, Betty Latner, Betty
Commerford, Mary Slack, Rick Rowan, Julie Kaneta, John
Chaplick, Frances Clohecy, Elizabeth Woodbridge, Rita Moses,
Marleen Lopresti, Margaretta Johnson, Kim Cipollone, Philip
Haggerty, Paul Pitman, Beulah Morrison, Nancy Dutton,
Jennifer Carpenter, Mary Ann Coyne, Dr. James Hughes, John
& Anne Kendrick, Pamela Chambers, Angela Crofford-Bik,
Ellen Ramil, Sr. Murielle Bourgeois, Darryl Anderson, Hyman
Kyett.
MICHIGAN: Sandra Nettleton, Kim Cook, Patricia Lacasse,
Paul Strobel, Ella May Evans, Marie Key, Joni Rainbolt, Sonya
Hoevener, Karen Frohlich, Steve Eisenberg, Evelyn Brown,
Angeline Grigorian, Paul Olson, Larry French, Janet Rea,
Carolyn Bush, Kenneth Aldrich.
MINNESOTA: Charles Olson, W.J. Morehead, Deborah
Wingert, Carmela Linker.
MISSOURI: Viola Wondraska, William Hodson, Marie Vohsen,
Olive Duffy.
MONTANA: Genevieve Grant.
NEVADA: James Darnell.
NEW HAMPSHIRE: Norma Moore, Mary Brick, Louise
Richard, Natalie Undercofler.
NEW JERSEY: Edie Novak, Pauline Newell, Mary Nallin,
Christopher Kane, Harry Bott, Anthony Celentano, Bill
Robinson, Katherine McGuire, Judy Budinsky, Sandra Polk,
Barbara Brown, Gladys Rude, John Mastandrea, Dr. Alexander
Hochheiser, Jill Levitt, Betty Johnsen, Gail Greenbaum, Harry
Bott, Patrice McDermott, Rosa Gavasci, Cathy Sogorka, Doyle
Smith, June Scallan, Wendy Lewis, Judith Jeannin, Brian
Packard, Ann Kohoot, Fran DeGregorio, Cathy Mele, Dr. Joel
Lehrer, Barbara Strongin, Jennifer Schutte, Donna Boyle.
NEW YORK: Elizabeth Stumme, June Feldman, Lucille
Wassmansdorf, Dr. David Edelstein, Saverio DeFrancisi, Patty
Busa, Carola Micheal, Olga Bursch, Lois Oestrich, Istvan Deak,
Dr. Kenneth Brookler, Calvin Oba, Nancy Mahler, Minnie Cook,
Rosalie Fanning, Lydia Chang, Mary Allegra, Kevin Sternberg,
Shirley Weiss, Robert Marsin, Anne Riga, Joan Tarr, Joseph
Haydasz, Dr. Mary Samuels, Rita Demers, Dr. Daniel Cohen,
Roscha Folger, Michael Thomas, George Holzmann, Hedi
Levenback, Randy Atlas, Dorisann Rinaldo, Alan Altheim,
Donna Troisi, Jeanne O'Leary, Rita Demers, Donna Martin,
June Feldman, Amy Clampitt, Catherine Nicolas.
NORTH CAROLINA: Terry Trotter.
NORTH DAKOTA: Franklin Van Osdel.
OHIO: Faye Ickes, Rod Hoffman, Matilda Courey, Marie
Fenley, Timothy Miller, William Braislin, Janet Hoffmann, Susan
Michelson, Helen & Richard Engdahl, Juanita King.
OKLAHOMA: Gene Halverson, Jean Tanner.
OREGON: Judy Sedacca, Maurice McCann, Tom Hashizume,
Charlotte Shupert, Edythe Allen, Gene Sigfrid, Elizabeth Shane,
Scott Moreland, Paul Boehler, Mr. & Mrs. George Krieger,
Bernd Crasemann, Hilda Hochhalter, Robert Stokes, Martha
Hogensen, Elmer & Darlene Griser, Dr. John Chester, Velma
Nicholson, Dorothea Radel, Kyle Gray, Theodore Norton, Bill
& Sue Anthony, Lois Jensen.
PENNSYLVANIA: Miriam Kring, Barbara Chant, Nancie Stupp,
Robert Barancik, Charles Batzig, Wendy Schoenewald, Berenice
Brown, Louise Blumenstein, Dr. James Martino, Neil Hopkins,
Monica Marwah, Doris Africa, Frances Gilbert, Fred
Fleischauer, Miriam Kring.
PUERTO RICO: Patria Echevarria.
RHODE ISLAND: Diane Chece, Louise Bottone.
SOUTH CAROLINA: Eugenia Hughes, Saundra Sharp.
SOUTH DAKOTA: Dolores Shanks.
TENNESSEE: Joella Peirce.
TEXAS: Dorothy Bering, Gale Robertson, Helen Barr, David
Bloomer, Beckie Simpson, R.P. Burnett, Stayton Bonner,
Dorothy Guthrie, Milton Sellars.
UTAH: Priscilla Davidson.
VIRGINIA: Linda Allen, George McAtee, Robert Hay, Arthur
Demerse, June Battaile, Dr. James Laffey, Lauren Berger,
Michael O'Neill, Jeanne Webb, Donna Mayer.
WASHINGTON: Robert & Dorothy McNeil, Linda Paros,
Charles Noble, Iola Kelly, Ann Kalberg, Ielene Edmonson,
Teresa Nelson, Sharon Covey, Betty Novak, Betty Donnerberg,
Helen Johnson, Ruth Howard, Mary Bartell, Gisela Shoda,
Bernard Horn, T. Roger Billeter, Marvin Carmichael, The
Williams Family.
WEST VIRGINIA: George Bennett.
WISCONSIN: Joan Orthober, Louise Zurawski, Charles
Sommerfeldt, Maureen Boll, Elaine Fouts, Ilse Tennis, Anne
Nadolny, Russell Oldenburg, Martha Recknagel, Mary
Bichanich, Leonard Rochwerger, Eugene Schmidt, Dr. Steven
Millen, Earl Burgan.
AUSTRALIA: Maxine Jacobi.
BAHAMAS: Barton Milligan.
CANADA: Lydia Francis, Susan McNally, Rosemary Derbecker,
Martin Smith.
JAPAN: Kay Ehrhart.
_________________________
ADVISORY BOARD
PICKS NEW LEADER
The National Deafness and Other
Communication Disorders (NIDCD)
Advisory Board elected Dr. Stephen
Epstein to be its new chairperson at a
recent meeting. The board provides policy
guidance to the NIDCD, which supports
research on mechanisms of balance,
hearing, smell, taste, voice, speech, and
language. Dr. Epstein, who replaces
Geraldine Dietz Fox, is a nationally
recognized specialist in pediatric otology,
said an NIDCD news release.