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Sound sensitivity can throw vertigo patients for loop
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| Helen Cohen, Ed.D. |
If the sound of your boss's voice drives you up the wall, there may be more to it than office politics. Inner ear specialists at Baylor College of Medicine in Houston are finding a surprising upswing in vertigo cases among people sensitive to specific frequencies.
"Patients will say, ‘When I hear loud sounds, I either feel like my eyes are fluttering, or my vision changes and I feel dizzy for a few seconds,'" said Helen Cohen, Ed.D., professor of otolaryngology at BCM. "One patient couldn't listen to his daughter talk because her voice – and not any one else's – made him light-headed."
Cohen and her associates at the BCM Center for Balance Disorders have traced a large percentage of these sound sensitivities to superior canal dehiscence, a miniscule irregularity in which a tiny bone in the inner ear erodes, disrupting the mechanisms that gauge equilibrium and sound, and causing vertigo. Many vertigo sufferers, especially those whose jobs involve loud machinery, are incapacitated from performing many daily activities.
The exact trouble spot inside the ear is not always readily apparent, which can lead to misdiagnoses and unnecessary operations. An accurate diagnosis is particularly critical if a patient undergoes surgical repair of the defect in the bone, a delicate operation that involves a craniotomy.
Fortunately, an accurate if relatively unknown examination called a vestibular evoked myogenic potential (VEMP) test can help differentiate among several causes of vertigo. Developed in the 1990s, but not used clinically until recently, the VEMP test identifies the specific site of injury to the inner ear and/or the balance nerve.
During the non-invasive VEMP examination, small recording electrodes are taped to the neck and shoulders of the patient. Sounds are presented to one ear while the patient's head is held in a certain orientation.
"This is a way to help get a handle on what might actually be happening in the inner ear once it is determined that the problem is not psychogenic, medication-related, or heart-related and after you decide it is something to do with the inner ear and the brain pathways related to the ear," said Cohen. Balance disorders have many causes, including head trauma, some medical problems, congenital defects, and a few antibiotics or chemotherapy.
VEMP tests are slowly gaining widespread practice but so far have been used primarily at academic institutions. Given the prevalence of gadgets with earpieces and headphones, Cohen foresees more manifestations of sound sensitivity.
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