Balance disorders can be incapacitating, affecting one’s ability to walk, drive and even sit or lie still without the sense of spinning, dizziness or lightheadedness. Although specialists often are able to diagnose these conditions with a simple history and physical exam, it is not uncommon that they are overlooked or misinterpreted outside of the expertise of a specialty center.
At UCLA Health’s multidisciplinary Neuro-Otology Program, neurologists who specialize in balance disorders work closely with neuro-otology surgeons such as Akira Ishiyama, MD, to evaluate and treat the full spectrum of neuro-otology disorders, including benign and malignant tumors, recurrent infections and disabling conditions resulting in loss of hearing and balance. That close collaboration across disciplinary boundaries — highly unusual for a program treating balance problems, Dr. Ishiyama says — is important given that symptoms such as dizziness can arise both from the inner ear and from other parts of the body, including the brain or the autonomic nervous system, and from migraine headaches.
“When patients have balance disorders, they need comprehensive neurotologic evaluation for accurate diagnosis and treatment,” notes Dr. Ishiyama, who collaborates with Gail Ishiyama, MD, a UCLA neurologist, in seeing patients with complicated balance disorders.
UCLA has been a leader in the diagnosis and treatment of balance disorders. The program’s Vestibular Function Testing Laboratory, established in 1961, developed the computerized analysis and rotary testing that continues to serve as the gold standard for assessment of vestibular function under the leadership of Drs. Robert Baloh and Vicente Honrubia. Dr. Baloh, a UCLA neurologist with a joint appointment in the Department of Head and Neck Surgery, pioneered the field of neuro-otology, training the majority of the medical neuro-otologists — board-certified neurologists who limit their practice to patients with balance disorders — currently in the field.
Most of the balance problems seen by the program’s neuro-otologists and neuro-otology surgeons can be successfully diagnosed and treated, resulting in dramatic improvements in the quality of patients’ lives, Dr. Akira Ishiyama notes. Patients with benign paroxysmal positional vertigo, an inner-ear disorder characterized by extreme dizziness with eye or head movements resulting from displaced calcium crystals in the inner ear, can be cured in the doctor’s office with a head-movement procedure referred to as canalith repositioning. The program also developed a powerful MRI scanner used to monitor the accumulation of fluid in patients treated for Meniere’s disease — a debilitating condition marked by repeated bouts of vertigo, tinnitus and hearing loss. Treatment programs also are tailored for patients with age-related gait and balance disorders, as well as balance problems associated with stroke, multiple sclerosis, Parkinson’s disease and inherited ataxia syndromes, among others.
UCLA also receives worldwide referrals for the treatment of a rare condition known as superior semicircular canal dehiscence (SSCD), in which the normal bony structure around the inner ear is opened, leading to unusual and highly debilitating auditory and balance symptoms. The auditory dysfunction includes hearing loss as well as internally amplified sounds such as heartbeats and eye movements; SSCD patients also experience severe dizziness from loud noises, along with brain fog, fatigue and headache.
“This condition was only identified in 1998, and it’s not commonly known,” says Quinton Gopen, MD, associate professor in the UCLA Department of Head and Neck Surgery. “As a result, a lot of patients bounce around from doctor to doctor, and when they say they’re hearing strange sounds inside their head, they are sometimes sent to a psychiatrist without any realization that there is an actual pathology causing this.”
Dr. Gopen, working in partnership with Dr. Isaac Yang in UCLA’s Department of Neurosurgery, has developed a minimally invasive surgical technique that patches the hole in the inner ear, restoring normal balance and hearing. Through a small incision in front of and above the ear, they create a window through which bone wax material is used to close the opening responsible for the symptoms. The surgeons have performed nearly 200 of these procedures, done under a special image-guided navigation system, with high success rates.
“If a patient is complaining of internal amplified sounds, there are very few things that can cause that other than SSCD,” Dr. Gopen says. “Those patients should be referred for this surgery.”