When you think of the five senses, you are probably not thinking “vestibular.” Divya Chari does, and she wants you to know that the inner ear does more than hear. It is also critical to how we perceive our body in space.
The Massachusetts (U.S.) Eye and Ear specialist is already shining new light on the forgotten child of sensory disorders, vestibular dysfunction.
What is vestibular dysfunction? It is a disturbance in the body’s balance system. It can interfere with activities of daily living. Diagnosis is a challenge, and without more exacting diagnostics, treatment is a trial-and-error slog that steals time from patients.
Divya Chari’s approach straps patients into a moving, tilting, rolling chair for a battery of tests designed to pinpoint the precise source of the problem.
Divya said her goal is to improve the diagnostics of vestibular disorders and treating it right the first time. Symptoms of vestibular disorders overlap considerably, so a major focus is to understand why a person is having symptoms and to differentiate vestibular disorders from one another.
“Vestibular disorders often get ignored in research on sensory dysfunction, even though they affect many people,” she said.
“But hearing is not the only thing that the inner ear does. Many of those patients also suffer from symptoms of dizziness, imbalance, and vertigo that lead to significant morbidity and reduced quality of life. Paying attention to those symptoms is important.
“There’s still so much we don’t know about the inner ear. Acute or chronic vestibular disorders can be more readily identified by the damage they cause, but many vestibular disorders are episodic in nature, meaning that people might have symptoms some days but not on others. The episodic nature of symptoms can make it challenging to come to a definitive diagnosis.”
Meniere’s disease and vestibular migraine are two disorders that pose a particular challenge because they have similar symptoms and a high rate of co-occurrence. Although treatments exist for both disorders, the treatments are very different.
How might this work on Vestibular Disorders change clinical practice?
“That’s the million-dollar question, and I think this is where our test battery has the potential to have a large impact” Divya said.
“Currently, we rely on clinical history for diagnosis. We ask questions about symptoms, then apply a defined set of clinical consensus criteria to the answers. That process is highly variable. It’s very patient-dependent and provider-dependent. We need better diagnostic tools to help us understand, diagnose, and tailor our treatments.
“If we can better differentiate definite Meniere’s from definite migraine, we might also be able to identify patients in the middle. Our hope is that this can be more broadly applied to a larger group of patients with vestibular dysfunction and inner-ear disease.
“Right now, we have a number of treatments for vestibular migraine, and other treatments for Meniere’s disease, but we often don’t know which one to use. We’ll try one and if that doesn’t work, we try another, and so on. It’s trial-and-error.
“Getting to a more definitive diagnosis quicker allows us to tailor treatment more effectively. That has the potential to decrease suffering and improve the patient’s quality of life much more quickly.”
“And getting to a more definitive diagnosis quicker allows us to tailor treatment more effectively. This has the potential to decrease suffering and improve the patient’s quality of life much more quickly.”
By Brenda Patoine for Harvard Catalyst.