Timothy C. Hain, MD of Chicago Dizziness and Hearing
Page last modified: April 14, 2019
Just published in 2019 is a new article by Dr. Cherchi on OCT (ocular coherence tomography) in vestibular disorders. Also in 2019, we published yet another chapter on Migraine associated vertigo.
As of May, 2018, we have also just published two new articles on bilateral vestibular loss in Frontiers.
A new treatment for chronic migraine has hit the "streets". Three of these drugs have now been approved since May 2018. They are generally "anti-CGRP antibodies" (Giamberardino et al, 2016). These drugs have not really lived up to their hype, and we do not find them useful for vertigo at all. I suppose -- why should a drug that blocks vasodilation help vertigo anyway.
Visual vertigo is a condition where patients are intolerant of situations where there are large amounts of visual stimulation -- examples include walking through the aisles of a grocery store, difficulties with viewing scrolling computer screens, and driving problems where the speed gets above a certain threshold (often superhighway). It is sometimes diagnosed as a migraine variant (e.g. vestibular migraine), as a psychiatric condition (e.g. PPPV), as an ocular disturbance (e.g. in patients with 3rd nerve palsies or otolithic problems), and as a reorganization to loss of vestibular sensation (e.g. visual dependence).
Some progress has been made in treating this condition by the optometry profession, through manipulation of eye-wear and visual exercises. We have recruited an OD to treat this condition, Dr. Marsha Sorenson. This is going well.
Dai et al (2014) reported successful treatment with a variant of motion sickness, Mal de Debarquement, with a 5 day adaptation protocol. For a few years we treated patients with our own version of this protocol, but we stopped due to the logistical difficulties. We are hoping right now to make some progress with a cheaper home-based VR protocol.
Chicago Dizziness and Hearing has the "VHIT" test machine, which is a device that quantifies the results of "head impulses". This is a new technology to assess vestibular function. It is very good in detecting unilateral vestibular loss, such as due to tumors or vestibular neuritis. It is also modestly useful in assessing vestibular compensation - -persons who are uncompensated have "overt" saccades, and those who are compensated have "covert saccades".
We also use the VHIT to follow patients with bilateral vestibular impairment, to decide whether or not they are getting worse. It is far less stimulating that the rotatory chair, and we sometimes use it in place of VENG/R-chair in motion sensitive persons. Again it is a little tricky as people can improve on the VHIT (due to compensation) but remain unchanged on the rotatory chair (when one considers the entire vestibular response). We have also found VHIT somewhat helpful in occasional situations where a "tie breaker" is needed between ENG and rotatory chair.
References to recent output.