Getting Dizzy With It!

Turning Heads is a podcast made for students, by students, at The American Institute of Balance.  We have a very unique opportunity here at AIB because we work almost exclusively with vestibular assessment and management. As clinicians who have shifted their focus towards dizziness, balance, and equilibrium, our goal is to provide resources to enhance your professional toolkit. We want to invite you to discuss the possibilities of our future as audiologists.

In this episode, we discuss the dizzy population, why we're interested in dizzy patients, and why we want to become vestibular audiologists/equilibrium specialists. 

If you have any questions or comments, reach out to us! Your question could be featured in a future episode.
Facebook: 'The American Institute of Balance- Resident Corner' 
Instagram: @TurningHeadsPodcast  

Going forward, future episodes will focus on topics such as bedside assessment, running a dizzy practice, interdisciplinary collaboration, how to succeed in your externship, and much more!

Transcript

[00:00:09.390] Hello and welcome to Turning Heads! As audiology students we are very familiar with our role in performing hearing evaluations and fitting hearing aids, but how well do we know the other specialties in our field? It almost feels.. out of balance. Today more than ever before, it’s important to take full advantage of our entire scope of practice and professional utility. As clinicians who have shifted their focus towards balance and equilibrium, our goal is to provide resources to enhance your professional toolkit, and we want to invite you to discuss the possibilities of our future as audiologists.

[00:00:48.690] My name is Clayton, I am from the University of Arkansas, originally from Nashville, but I've been living in Arkansas for about seven years now. 

 My name is Christina. I am an audiology student at University of South Florida. I've lived in Tampa pretty much all my life, went to University of Central Florida for my undergrad in Interdisciplinary Science.

[00:01:09.330]  Hello, my name is Paxton. I'm coming from the University of Kansas and my undergraduate was from the University of North Dakota.

[00:01:18.840] And last, but not least, I'm Courtney. I'm from the University of Wisconsin and I'm excited to be here. I'm excited to get started and share our information with all of you.

 [00:01:29.280] We have a very unique opportunity here at AIB. We're almost working exclusively with vestibular patients, occasional audiometric testing, and occasional hearing aids, but mainly vestibular. We all came here for a very specific reason. So, what is it that that draws us as externs and as future professionals to the dizzy population?

[00:02:02.550]Personally, I think what first drew me to this population is just the idea of how underserved they are. On average, patients that are dizzy will see five providers before getting a proper diagnosis and I just think that there's a lot of patients that need our care and our expertise. So I just really wanted to go into this area because I wanted to help patients, which I think is what we all can agree is why we went into the field of audiology in general.

[00:02:19.590] Absolutely. 

 I think you definitely see a different side of audiology in the patient population. 

 Oh, definitely. 

 That's the biggest thing for me. You have people who are in denial about their hearing. Maybe it takes them a while to warm up that to the idea of getting a hearing aid or they try to compensate for their hearing loss; but that's not how it is with dizzy patients. You can really see the pain and suffering from getting the get go.

 [00:02:48.520] Yeah, most of our patients are desperate for help and they're desperate for answers.
[00:02:53.470] I would agree. Knowing that people would drive hours to go see someone if they are able to test and treat their dizziness or their disequilibrium is powerful. Knowing that you can help so many people.. that's personally what has really driven me to become the best that I can be in this area of the field, because it's so needed.

 Just the power of being able to heal somebody on the spot with your hands and your words. Patients are so grateful that you can help them and it's almost like they're in disbelief that some of the treatments that we do are that easy and it was causing them that much distress in their life. Other than that, I think the main reason why I really love what we do here is that we fill a very specific niche within the world of health care that many other people don't really know how to fill. So like Courtney was saying, patients get shuffled around to five providers before they get to the bottom of their dizziness.

 [00:03:55.210] Yeah.

 And that's incredible to me because not only are patients desperate to get in here and get treated, but any physician in the area has a pile of papers with patients that are dizzy that they don't necessarily know what to do with. Being able to provide that service not only to our patients, but to the medical community itself is to me the most important thing. Because, you know.. We are the specialists of the ear. We shouldn't be ignoring half of the ear, especially anatomically and physiologically, you could argue it's the more important half of the year because--

 I mean, it develops first.

 --Gestationally it was the first to develop and it's what we rely on earlier in life. 

 Yeah, I totally agree.

 Even in utero, any animal or any person needs to understand where ‘Mother Earth’ is before they can ambulate and before they can function. So.. I'm not really sure where I was going with that rant but I like where it ended. 

 (laughing)

 [00:04:51.400] But I think an easy way to say this is that “you can live without hearing; you can't live without balance”. So they understand “the why” now, they understand why we're doing what we're doing, but what about the things that we've seen? Do you have any patients in mind? And what's the patient population that you're working with? Have you had any experiences that you could share with us during this externship?

 [00:05:15.640] One day I saw an age range from thirteen to ninety two. So with Dizzy you aren't with only the geriatric community and you're not with only pediatrics; your day changes so greatly that tomorrow I could see a whole different case of patients.. I could see all young, I could see all older, and I could see everything in between. So that's one thing that I really enjoy about vestibular assessment is that you never know what you're going to get. It's really just a coin toss, so to speak.

 [00:05:51.370] 
Yeah. And I think it's also good to note, not only do we have variety and ages and demographics but we have variety in what the patients are presenting with. Do they have imbalance? Do they have vertigo? Do they have dizziness? Do they have headaches? It just it varies day to day.

 [00:06:09.010] I also think that yes, you have different disorders. Yes, you have different ages. But at the at the nitty gritty, it's different treatment. It’s not the same thing every single day.

 [00:06:22.300] Yeah. 

 Which is what makes it so exciting for me.

 [00:06:24.160] Well, that's also because we treat each person as an n of one (n=1). So every person that walks in the door is a brand new patient. They are not treated the same, wqe don't go through a recipe approach of protocol. Every person who walks through the door, we treat them like we've never seen them before and we go from there. We do what's best for the person, not what's best to get them in and out quickly. 

 [00:06:48.490] Mm hmm. Yeah, we're not technicians here. Our main goal isn't to just push the buttons, run the tests and get the recordings. Our main goal is to use those tests as tools but in the end, it's our knowledge, it's our information and it's our background that's going to help treat these patients. And treating them as, like Paxton said, an n of 1. So each patient is different and we treat it as such. 

Yeah. And going off of that, just because before we were talking about healing people with your hands, you can also heal someone with your words. So recognizing when somebody has nothing that we can quantify what is wrong with them. A lot of times, we like to say to patients every day here, “there's not a dizzy patient in the whole world that isn't also anxious at the same time”.  So it is important to reassure them that, “yes, I see this all the time” and acknowledging their frustrations and their limitations in life. I don't know how many times patients have said to me, “So basically you're telling me there's nothing?”  “You can't find anything wrong with me?” or “we don't know what's wrong with me?” No, not necessarily. This is a very important part of a ruling out process. In fact, I would argue the most important part - being that the ears are the majority of your sensation of balance. So guiding them through that, guiding them towards being dedicated to their treatment and being dedicated to Physical Therapy (PT) or other providers that would be better equipped to treat that patient is arguably one of the most important parts of our job.

 [00:08:24.560] Mm hmm. And I think there might be some people out there who say, “oh, well, Ear Nose and Throat physicians (ENTs) don't work well with audiologists” and there's this idea within the audiology community, which I wholeheartedly disagree with. But I think there's this preconceived notion--

Yeah. Me too. 

 --That physicians and audiologists don't really get along. But I think that all comes down to the fact that you need to build that relationship, build that trust, show that you know what you're talking about, and I think a respect can be developed there. I haven't had any really any issues since being here in terms of interprofessional collaboration.

 [00:09:00.510] And part of that, I think, is that we are filling this niche for these doctors. They don't know what to do with dizzy patients. You know, they've tested this, they've tested that, all their levels are normal. They can't figure out why they're dizzy. We fill that space for them. We are a tool that they can use. “Oh, my patient feels dizzy. Let me rule-out the inner ear. Let me see what they think it might be going on.” And then they appreciate a call from us being like, “oh, you know, I didn't see any abnormalities but this is what I saw in office” and “what do you think about this playing a factor into their signs and symptoms, considering you know the rest of their medical history?” Things like that. That's usually how our conversations go with them. It's very back and forth and reciprocal. 

Yeah, exactly.

 [00:09:42.550] I do think too, just talking about it from externship standpoint: what are you training to be? Are you training to be someone who can do what a technician can do or are you training to be someone who is really independent and can hold their own when talking to a physician or talking to a physical therapist or whoever? And that's not to say.. Even if you are into hearing aids, how are you treating how are you treating that position? Are you someone who just learns to push some buttons and all of that? Are you constantly trying to develop your skills to be smarter than you were before?

 [00:10:24.260] Even going over a lot of the aural rehabilitation type stuff. That's all within our scope of practice.

 [00:10:27.140] Tinnitus Rehab. 

Yeah, exactly. We can be a tool for our patients. We can provide services that nobody else can provide. And if you ask me, no matter which field I'm in, that is the most important part is just that I'm serving my patients, not that I'm necessarily getting reimbursed for every single little thing I'm doing or this or that.

[00:10:57.230] And that builds rapport with your patient population. I mean, I don't know how many times we've treated patients for BPPV and then they're banging on our door to get hearing aids here. You're even though hearing aids aren't something we specialize here, we've built such a strong connection with these patients, this trust with them, that they don't want to go anywhere else. And I think that's something good to note off of Christina. Even if it's just not balance, if you're working with your patients and you're showing that you care and you take the time with them and listen to what they're saying, I think that builds a relationship and that's very, very important between patient and provider.

 [00:11:23.240] As a patient yourself, think about it. The only thing that you want when walking out of a doctor's appointment is to feel heard, valued and respected. And if we can give them that, no matter what type of audiology that we provide, that is the goal. 

[00:11:41.480] All right, guys. So what are some things that you learned or are learning that you didn't think that you would you would have learned?

[00:11:48.680] I think the biggest thing I've learned that I really didn't learn outside of my classroom.. So in our class, we learned about the VNG (videonystagmography) and we learned a little bit about BPPV (benign paroxysmal positional vertigo) and just really covered the basics. And initially going into this, I thought, “oh, I need to study the tests. I need to know about vHIT (video head impulse test) and VEMPs (Vestibular electromyogenic potential) and Rotary chair, and I need to know all of the specific tests”, but little did I know that you really have to look at the bigger picture.

 [00:12:14.660] And to be honest.. any test in vestib is not really a great test. They're all very small components and shouldn't be taken in isolation. You kind of have to piece by piece together the big/whole picture, and then from there [going back to your question Clayton] I feel like you deal with a whole different cohort of medical professionals that you may inter-collaborate with. So getting to know a lot about neurology and when to send patients to neurology versus physical therapy is important as well. Here at AIB, we actually have therapists in-house. So we do get to see the patient from diagnosis [maybe treat some BPPV along the way] and then see them out through their therapy with PT - which is an incredible experience, probably one of my favorite experiences here. How do you guys feel about that?

[00:13:10.250] It definitely puts it all in perspective because you end up thinking about like.. I don't know if you look at research and you just go like, “well, I don't need to know this.. This isn't in my wheelhouse, I don't need to know this.” I think the biggest thing that has stood out to me is exactly what you're saying - It really does highlight what it's like working alongside other people.

 [00:13:33.170] Absolutely. The interprofessional collaboration is probably the highlight for me as well. And that's very similar to what you just said, Christina. When we can have a patient that comes in and say they've got some blood pressure complications, if we can call their primary care and have a conversation that is best for the patient and it's also just incredible respect among professionals.

 [00:13:57.110] I think all of us are really saying, you know, we aren't hitting on all the cool tests we do and all the fun technology we have. It's great to have those tools in your toolbox. But I think I mean, I don't want to speak for everyone here, but I think we all just really enjoy treating our patients as people and really making their concerns validated because a lot of times patients are told, “oh, you're getting old. That's why you're falling a lot.” Well, I mean, that's just not that's not a good thing to be telling our patients. Falls are the leading cause of accidental death in people over the age of sixty-five and I don't think patients who are falling should be written off as, “oh, it's just getting old.”

 [00:14:40.490] Well, and two of the main risk factors for falling are a history of falls and fear of falling. So, if you're just sending them out the door without giving them tools on where to go from here or what they can be doing at home to prevent falls is not going to solve the situation. I think personally, one of my most memorable experiences here thus far has been the patient experience. Everyone that comes through the door is different and being able to see them change from the beginning of the appointment to the end of the appointment is truly noteworthy.

 [00:15:16.430] Yeah, it's a really rewarding thing to see a patient come full circle on you. A lot of what we've been touching on is our patient population, but also just walking through the mental processes that you go through when you are seeing them, you're thinking of different things. You're looking at all aspects of their life. You're not just a technician pushing buttons. You know, like Courtney said, you're not just fixating on the equipment that you have and what the test results show.

 [00:15:47.720] You're talking to your patient the whole way through. So you not only become a healer, you not only become a medical concierge, but we're also health advocates for that person. So we're taking into consideration what they're saying when nobody else has listened to them. We are truly caring for their emotional state of mind as well as their physical state. 

 And I think, too, like I think this podcast, you know, I think it's our next episode we're going to be discussing what can you do as a student, as a young professional in the field to help this patient population?

[00:16:28.610] Even if you don't have even the most basic VNG equipment with Calorics, what can you do to test your patients fall risk? What can you do to assess whether or not “is it the ear, is it not the ear? Where can I refer to?” Because I think everybody needs to be looking and asking these questions with their patients because there is so much overlap between our hearing aid patients and the dizzy patients.

 [00:16:55.940] All right, guys, so we've gone over a lot today. We've talked about why we came to AIB, why we're interested in dizzy patients and really even talking about why we want to become vestibular audiologists or equilibrium specialists. Now, this is a student lead podcast, and we want to hear from you. What questions do you have? So there's some ways that you can reach out to us, either at Facebook, at AIB Resident’s corner or on Instagram TurningHeadsPodcast (all one word), if you're lucky, your question could be featured in a future episode! Going forward we’ve got some special guests here that are going to come in, we will interview them, and you can talk a little bit more about individual topics of that day.

 [00:17:39.850] So in any case, thanks so much for tuning in. We'll see you next week. 

 Bye guys!

 All right, fun fact of the day. Have you heard of Alexander Krumm Brown? He was a professor of chemistry and chemical pharmacy at the University of Edinburgh in Scotland, and he's a forgotten pioneer of vestibular science. He theorized that the semicircular canals were paired together and that motion intolerance was due to a sensory conflict between the eyes and the vestibular system. Both of these theories contribute to our understanding of the vestibular system today. 

 [00:18:16.690] 
Hey, if you're someone who's interested in learning more about the diagnostic and rehabilitative aspects of the vestibular and equilibrium sciences, AIB is now offering a university program online for audiology students. Ask your program directors if your university will offer our course as part of the curriculum and if not, reach out to us! We also offer the course on an individual basis for just the price of a textbook.