LM211 - Simplifying Advanced Vestibular Cases

Abstract:
Vestibular evaluation and management have changed dramatically along with better understanding of disorders that cause dizziness and imbalance and new diagnostic tests. Most audiologists had little vestibular coursework and rotations during their university training, but audiologists are critical components of the multi-disciplinary assessment of dizziness and imbalance. The focus of this session is to understand vestibular disorders, diagnostics, and treatment through a case study approach. Topics covered include advanced case study presentations, case history considerations, vestibular test battery options, creating and maintaining good relationships with referring providers, and physical therapy management.

Summary:
In the US, it is estimated that 35% of adults age 40 years and older and 85% of adults age 80 and older have balance dysfunction. Patients with vertigo and dizziness increase medical expenditure and utilization across healthcare sectors with a total US annual cost to manage these patients of $48.1 billion (Ruthberg et al., 2021) with a higher cost burden for recurring disorders such as Meniere’s disease, vestibular migraine, and BPPV (Jeong et al., 2022). In 2015, 8.5% of people worldwide (617 million) were age 65 and older. By 2050, this is reported to jump to nearly 17% of the world’s population (1.6 billion; He et al., 2016). Like hearing needs, vestibular testing needs will grow substantially as a result. While vestibular services are within our scope of practice, many students and clinicians either lack the educational background or are not comfortable with providing vestibular services to patients. It is not just audiologists who are inadequately trained as the vestibular system is perceived as complicated and poorly taught in medical school and residencies to medical providers also (Weinreich et al., 2021).

Multifactorial dizziness and imbalance concerns are not uncommon and audiologists need to help differentiate these signs and symptoms. Asking relevant case history questions help guide our initial decision-making for appropriate diagnostic tests to perform and understanding how to use our testing properly to help confirm or deny our suspicions. Referring medical providers typically want us to help determine if there is a peripheral or central vestibular involvement and to possibly provide recommendations or insight on next steps for the patient. Rehabilitation specialists rely on our test results and input for developing and implementing patient plan of care. Therefore, audiologists are an important part of the multidisciplinary team for patients with dizziness and imbalance.

This session will discuss the role of audiologists in the multidisciplinary team for patients with dizziness and imbalance. We will discuss evaluation and management of different, multi-level vestibular and non-vestibular causes of dizziness and imbalance through a case study approach. Effective report writing and communication techniques with the referring provider and rehabilitation specialists will be reviewed for each case.

Agrawal, Y., Ward, B. K., & Minor, L. B. (2013). Vestibular dysfunction: prevalence, impact and need for targeted treatment. Journal of Vestibular Research: Equilibrium & Orientation, 23(3), 113–117. https://doi.org/10.3233/VES-130498.

He, W., Goodkind, D. & Kowan, P. (2016). An aging world: 2015. U.S. Government Publishing Office.

Ruthberg, J.S., Rasendran, C., Kocharyan, A., Mowry, S.E., & Otteson, T.D. (2021). The economic burden of vertigo and dizziness in the United States. Journal of Vestibular Research, 31(2), 81-90.

Jeong, S. S., Simpson, K. N., Johnson, J. M., & Rizk, H. G. (2022). Assessment of the cost burden of episodic recurrent vestibular vertigo in the US. JAMA Otolaryngology - Head & Neck Surgery, 148(12), 1103–1110. Advance online publication. https://doi.org/10.1001/jamaoto.2022.3247.

Weinreich, H.M., Martin, E., & Agrawal, Y. (2021). Overview of dizziness in practice. The Otolaryngologic Clinics of North America, 54(5), 839-852.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is recognition of complex vestibular and non-vestibular causes of dizziness with an emphasis on effective case history, report writing, and communication techniques. Vestibular audiologists should be able to incorporate these items in clinic after attending this session.