Vol. 10, No. 2, Spring 1993 A Word To Vestibular Citizens By Jane Mahoney If you have encountered the disabling effects of vertigo or are close to someone who has an inner ear problem, then you're well aware of the need for extended research in vestibular medicine. It's estimated that more than 76 million Americans living today will suffer from inner ear problems sometime during their lives. Many will find relief. Without the benefit of advanced research, however, many will encounter conflicting diagnoses, discouraging setbacks, and insufficient therapies -- perhaps for a lifetime. If only more were known! As a vestibular citizen, your call for continued research can be heard. Some of the best vestibular research in the U.S. is funded by the National Institutes of Health (NIH). The NIH is funded by Congress. And Congresspersons, whose votes establish NIH priorities, listen to their constituents. You can help educate your Senator or Representative on vestibular concerns through a simple note or phone call. Because people with vestibular disorders can appear healthy despite significant disability, the serious nature of vestibular disorders can be underestimated. Education is a vital tool for building public awareness. Advocacy brings results: cancer research, heart research, and AIDS research have all benefitted from strong constituent response. Currently, the NIH funds research on balance and dizziness through its institutes of aging (NIA), deafness and other communication disorders (NIDCD), neurological disorders and stroke (NINDS), and center for research resources (NCRR). Research efforts have met with success. Still, much remains to be learned about cause, diagnosis, surgical techniques, treatment, and rehabilitation of inner ear problems. Despite a critical need for more knowledge, research on balance and dizziness remains a minor funding priority with the NIH. When the NIH pays for research at hospital and university centers, new discoveries are made. For instance, the Johns Hopkins Center in Hearing and Balance, in Baltimore, is a major NIH site for research. Focusing on diagnostic and treatment strategies, the center has introduced innovative rehabilitation programs. Another example is the UCLA Balance and Dizziness Research Program, in Los Angeles, which uses NIH support to integrate the disciplines of neurology, otolaryngology, and ophthalmology. This center specializes in the diagnosis and treatment of disorders of the inner ear and of eye movement. In its brochure, "Dizziness: Hope Through Research," the NIH notes the importance of vestibular research: "With support, scientists are searching for better ways to diagnose and treat dizziness. . . . These studies, along with basic research on how the ear, brain, and nerves work, hold the best hope for relief for dizziness sufferers." If you write or call your Senator or Representative advocating more NIH funding for research, be short and concise. Congress should know that funding is needed for both basic science research (discovering how the inner ear works) and for clinical research (developing improved treatment strategies). The following statistics, issued by the NIH and included in the VEDA fact sheet, "Did You Know?" might help you present your argument: Over 42% of the American population aged 17 and older have complained of vertigo or dizziness. Balance-related falls account for more than half the accidental deaths in the elderly. The cost of medical care for patients with balance and dizziness disorders exceeds $1 billion a year in the U.S. alone. (If you are not a U.S. citizen, you may learn about your country's vestibular research by writing or calling your local government or library.) In the past 10 years, the diagnosis and treatment of vestibular disorders has improved dramatically. More research can help thousands more lead a vertigo-free life. ________________________ NIH RESOURCES AVAILABLE The following information is available free-of-charge from the National Institute of Health NIDCD Clearinghouse: "Dizziness: Hope Through Research" (brochure) "Balance Disorders Organizational Resources" (fact sheet) "Acoustic Neuroma" (fact sheet) "Because You Asked About Meniere's Disease" (fact sheet) CHID (computerized bibliographic database). Contains references to health information and health education resources. For more information write NIDCD Clearinghouse, PO Box 37777, Washington, D.C., 20013 or call (800) 241-1044 (voice) or (800) 241-1055 (TDD/TT). NEWS AND REVIEWS By Susan L. Engel-Arieli, M.D. Below are summaries of articles that appeared in recent medical and professional journals: 1. Best Shoes for Balance? -- People such as the elderly who are susceptible to balance problems have generally been advised or have chosen to wear athletic shoes with thick soft soles. A recent study indicates that a hard stiff sole may be more able to transmit position information to the foot. Such a sole is less comfortable, but a group of researchers says that people who have fallen or who have balance problems should avoid shoes with thick floppy soles and that walking barefoot may also be less safe. See Robbins, S., et al., "Shoe Sole Thickness and Hardness Influence Balance. . .," Journal of the American Geriatrics Society, 40, November 1992, pages 1089-1094. 2. Rehabilitation Therapy for Balance Disorders -- Dr. Konrad, et al., say that research suggests that rehabilitation therapy should be specifically designed for each person with vestibular or balance problems. They also indicate that to be most effective the therapy should start soon after the problems have begun and that some medications to treat the disorder may actually reduce recovery. Patients with benign paroxysmal positional vertigo or one-sided vestibular disorders with no brain involvement seem to respond best to therapy. Patients with Meniere's disease generally may not respond as well, and those with a central component (brain involvement) may respond more slowly. See Konrad, H.R., et al., "Rehabilitation Therapy for Patients. . .," Otolaryngology -- Head and Neck Surgery, 107(1) July 1992, pages 105-108. 3. Treatment for Chronic Neck Pain After Whiplash? -- Whiplash injury, usually caused by sudden movements from a car accident, can produce chronic vertigo or dizziness and pain and/or reduced mobility in the neck, upper back, and shoulders. A recent Swedish study indicated that in a limited study of 40 patients, the majority of patients had relieved or much-relieved pain after subcutaneous injections of sterile water in the affected area. The report says patients experienced an initial stinging pain for about 30 seconds and that most required two to four treatments over about six months. The authors state they have been successful with hundreds of patients, but not everyone has continued with diminished pain. No specific mention was made of vertigo. See Byrn, C., et al., "Subcutaneous Sterile Water Injections. . .," The Lancet, Vol. 341, No. 8843, Feb. 20, 1993, pages 448-452. 4. Safer Test for Studying Blood Vessels -- Researchers at the House Ear Clinic, Los Angeles, report that, based on a review of 25 patients, magnetic resonance angiography (MRA) is a useful procedure for evaluating major blood vessels. (Abnormal blood vessels can cause vertigo.) MRA reduces the risks of angiography (another test often used to study blood vessels), which include stroke, kidney damage, radiation damage, blood-vessel injury, etc. See Rodgers, et al., "MRA: Analysis of Vascular Lesions . . .," American Journal of Otology, 14(1), January 1993, pages 56-62. 5. Acupuncture and Tinnitus -- Doctors from Sweden recently used acupuncture to treat patients with severe and continuous tinnitus. Statistical analysis did not show any significant improvement. See Nilsson, et al., "Acupuncture for Tinnitus. . .," Scandinavian Audiology, 21(4), 1992, pages 245-251. 6. Vertigo in Children -- A medical paper published in France states that the main difference between childhood and adult vertigo is that evaluation poses special challenges in children depending on their age. Vestibular disorders are not distributed in the same way among adults and children, and often the diagnosis in children cannot be considered final, the paper says. The authors suggest more study is needed. See Morgan, A., "Vertigo in Children," Annales de Pediatrie, 39(8), October 1992, pages 519-522. 7. Testing for Recurrent Vertigo with Syncope -- Recurrent vertigo associated with syncope (fainting) or near syncope with no apparent cause is perplexing. Physicians at the Medical College of Ohio have studied patients in this category, using an upright tilt-table test. If patients had a positive test result, indicating some type of vasovagal (blood vessel - vagus nerve) problem, they were treated with drugs such as scopolamine. Each tilt- positive patient on treatment eventually became tilt-negative, with no more vertigo or syncope. See Grubb, B.P., et al., "Head- Upright Tilt Table Testing. . .," Otolaryngology -- Head and Neck Surgery," 107(4), October 1992, pages 570-6. Here are summaries of articles appearing in non-technical publications: 1. Nail Polish and Dizziness? -- Toluene, a solvent in nail polish, can penetrate nails and enter the blood. It may be the cause of occasional bouts of dizziness and nausea. Reportedly, Revlon, Almay, OPI, and Matrix have stopped using toluene. (You may want to check the ingredients on your nail polish.) A similar-sounding compound, toluenesulfonamide/epoxy resin, apparently does not pose any threats, a recent article said. See "Could Nail Polish Make You Dizzy?" Woman's Day, Feb. 2, 1993, page 20. 2. Silence the Buzzing -- Tinnitus (ringing or noise in the ear) is increased by muscle spasms, stress, and tension. According to a recent article, up to 80 percent of tinnitus patients using biofeedback report some reduction in buzzing, while about 20 percent report total elimination. See Stocker, S., ". . . Silence the Buzzing in Your Ears," Prevention, February 1993, page 144. 3. Chronic Headaches -- Researchers at Rush-Presbyterian St. Luke's Hospital in Chicago state that some chronic headaches that don't respond to other treatment can be soothed by fluoxetine, an antidepressant. See Health Confidential, March 1993, page 2. 4. Over 'n' Out -- A recent article discusses the malady of motion sickness, says that about 26 million Americans suffer from it, and gives tips for avoiding it. The tips are simple but hit home: avoid situations likely to produce motion sickness; ride in the front of a car or bus; if possible, drive the car or bus; take motion sickness medicine before you start activity that may produce motion sickness; try to sleep during the activity; avoid alcohol. The article includes an interview with Dr. Timothy Hain of Northwestern Memorial Hospital in Chicago who discusses the causes and treatments of motion sickness. Also, information is provided on reducing motion sickness in children. See Vettel, P., "Over 'n' Out," The Chicago Tribune, Section 17N, Jan. 10, 1993, pages 1 and 5. 5. Ataxia and Its Implications -- In response to questions, Dr. S.H. Subramony of the University of Mississippi Medical Center in Jackson states that smoking sometimes aggravates ataxia, a balance disorder, but it is not known if caffeine worsens it. However, he states that caffeine has many effects on nervous system enzymes and pathways. Dr. Subramony adds that fatigue is common in ataxia and other neurological disorders. The exact reason for the fatigue is not known but does not seem to lie in the muscles. See "Dr. Subramony Explains Balance," Generations, Vol. 20, No. 4, December 1992, pages 12-13. Author's Note: Please note that neither Dr. Engel-Arieli or VEDA can recommend or be responsible for an individual's reaction to a particular treatment. These reviews are not intended as a substitute for professional health care by your own physician. Please do not begin any treatment without first checking with your physician. NEW MATERIALS AVAILABLE FROM VEDA VEDA recently added the following items: B-3: Stories and Strategies: Coping With Vestibular Disorders, 61 pages, personal stories written by VEDA members, $6. B- 3 was in the final editing stages as this newsletter went to press. It should be available in late May. "L-0: Books," 5 pages, a selected bibliography (list) of technical book-length works on vestibular disorders. This list fills a gap in our L-1, L-2, L-3 bibliographies, which list articles but not books. This list is free to members. To receive L-0, please send a self-addressed long envelope with 29 cents postage. "L-3: Bibliography 92," 35 pages, a selected, annotated list of recent technical (peer-review) articles on vestibular disorders. This is the third in VEDA's series of annual bibliographies. The price is $10. THANK YOU We thank all of the following for their contributions to VEDA through April 5: Associates ($100 to $499): Schultz Foundation Inc., FL; Steven Smith, MI; Dr. Gerald Labriola, CT; Cindy Goral, CA; Sue Parks, WA; Dr. Jeffrey Kramer & Dr. Jordan Waxman, IL; Edwin D. Martin, FL; Naomi Lederer, NY; Mr. & Mrs. W.C. Cooke Jr., VA; Dom Celentano, NJ; Dr. Sidney Busis, PA; Norman Griner, NY. Contributors ($10 to $99): ALASKA: Donald Abel, John Loomis, Lawrence Palmer. ARIZONA: Gail Walker, Marjorie Rolfe, Charles Hartwell, Doris & Fred Guilford, Norma Raya. ARKANSAS: Margaret McCrady. CALIFORNIA: Patricia Coats, Karolyn Zebarth, Susan Atchley, Rachel Brokaw, Joann Caouette, Therese Mifek, Jon Crawford, Faye Taylor, Shirley Englander, Jeanette Brown, Mary Minando, Betty Hwang, Patricia Spinosa, Lillian Kuhn, John Pino, Jack Goodman, Beverly Peterson, Karolyn Zebarth, Alex Sherman, Mary Sanchez, Rachel Frese, Jon Crawford, Floyd Paul, Thomas Scott, Charles Kuhns, Lee Beckom, Ruth Corson, Mario Persico, Geraldine White, Arvind Sakliker, Bonita Runge, Carol Labadie, Jerrene Ricci, Marie Ralph, Vee Robinson, Myron Roth, Suzanne Cresswell PT, Roger Webster, Anne Phillips, Anne Walston, Mary Walker, Mary Lou Wood, Marguerite Brinegar, Rita Manuelli, Lee Law. COLORADO: Vivian Saltus, Mary & Don Edgington, Lori Kaplan, James Gliozzi, Marilyn Girouard, Michael Derr, Kim Buchwald, Ralph Oscarson, Abraham Shapiro, Lydia Coulter, Paul & Myrna Sunberg, Don R. Anderson. CONNECTICUT: Dorothy Coughlin, Dr. John Kveton, Kenneth Brown. FLORIDA: Virginia Brown, Lillian Archer, Gloria Massry. Tess Cole, Lucille Anderson, Phyllis Cohen-Hartzman, Joan Kostenbader, Pauline Edgett, Jeremiah Daly, Daryl Chapin, Catherine Beale, Tess Cole, Robert Lee, Brenda Danback, A.H. Duvall, Abe Tannenbaum, Hannah Polansky, Patricia Kennedy, Wilfred Starr, Lorraine Bridges, Kathryn Karpowicz, Mrs. Winthrop Bancroft, Henry Chaffee, Phyllis Cohen-Hartzman, Susan & Jeff Kaye. GEORGIA: Louise Williams, Sally Foster, Rufus Jones, Patti Hallowell, Kathy Gaines, Mrs. Eric Tiller, James McCloskey, Elizabeth Spiegel. IDAHO: Deborah Haveman, Mrs. Vernon Peterson, Grant Ipsen. ILLINOIS: Charlotte Palmer, Annette Koltveit, Ruth Fullerton, Joseph Pompei, C.F. Moculeski, Thomas Casey, Mr. & Mrs. Donald Anderson, Carl Lund, Margaret Berzin, Phyllis Johnson, Mildred Walter, Elsie Ryan, David Lersch, Teresa Campana, Richard Wasser, Gail Scully, Jesse Irick. INDIANA: Paula Long, Grama Bhagavan, Louise Clark, Mildred Ertz, Jill Moore, Arline Newman. IOWA: Virginia Ryan, Dorothy Hatala, Barbara Clark. KANSAS: Imogene Leard, Mr. & Mrs. Jack Warner, John Voss, John Webb, John Peterson. KENTUCKY: Helen Carson, Sharon Nieman, Mary Williams. LOUISIANA: AnneMarie Maher, Phyllis Chatman. MAINE: Carol Ripley, Linda Dowell, Mary Dyer. MARYLAND: Shirley Friedman, Phyllis Zheutlin, Charlotte Davey, Muriel Engel, Earl Marsh, Stanley Oliver. MASSACHUSETTS: Virginia Strauss, Marie Leonard, Anna Hendricks, Michael Impastato, Eleanor Stichweh, Francis Fay, Beulah Morrison, M. Fatima Martins, Betty Latner, Betty Commerford, Mary Slack, Rick Rowan, Julie Kaneta, John Chaplick, Frances Clohecy, Elizabeth Woodbridge, Rita Moses, Marleen Lopresti, Margaretta Johnson, Kim Cipollone, Philip Haggerty, Paul Pitman, Beulah Morrison, Nancy Dutton, Jennifer Carpenter, Mary Ann Coyne, Dr. James Hughes, John & Anne Kendrick, Pamela Chambers, Angela Crofford-Bik, Ellen Ramil, Sr. Murielle Bourgeois, Darryl Anderson, Hyman Kyett. MICHIGAN: Sandra Nettleton, Kim Cook, Patricia Lacasse, Paul Strobel, Ella May Evans, Marie Key, Joni Rainbolt, Sonya Hoevener, Karen Frohlich, Steve Eisenberg, Evelyn Brown, Angeline Grigorian, Paul Olson, Larry French, Janet Rea, Carolyn Bush, Kenneth Aldrich. MINNESOTA: Charles Olson, W.J. Morehead, Deborah Wingert, Carmela Linker. MISSOURI: Viola Wondraska, William Hodson, Marie Vohsen, Olive Duffy. MONTANA: Genevieve Grant. NEVADA: James Darnell. NEW HAMPSHIRE: Norma Moore, Mary Brick, Louise Richard, Natalie Undercofler. NEW JERSEY: Edie Novak, Pauline Newell, Mary Nallin, Christopher Kane, Harry Bott, Anthony Celentano, Bill Robinson, Katherine McGuire, Judy Budinsky, Sandra Polk, Barbara Brown, Gladys Rude, John Mastandrea, Dr. Alexander Hochheiser, Jill Levitt, Betty Johnsen, Gail Greenbaum, Harry Bott, Patrice McDermott, Rosa Gavasci, Cathy Sogorka, Doyle Smith, June Scallan, Wendy Lewis, Judith Jeannin, Brian Packard, Ann Kohoot, Fran DeGregorio, Cathy Mele, Dr. Joel Lehrer, Barbara Strongin, Jennifer Schutte, Donna Boyle. NEW YORK: Elizabeth Stumme, June Feldman, Lucille Wassmansdorf, Dr. David Edelstein, Saverio DeFrancisi, Patty Busa, Carola Micheal, Olga Bursch, Lois Oestrich, Istvan Deak, Dr. Kenneth Brookler, Calvin Oba, Nancy Mahler, Minnie Cook, Rosalie Fanning, Lydia Chang, Mary Allegra, Kevin Sternberg, Shirley Weiss, Robert Marsin, Anne Riga, Joan Tarr, Joseph Haydasz, Dr. Mary Samuels, Rita Demers, Dr. Daniel Cohen, Roscha Folger, Michael Thomas, George Holzmann, Hedi Levenback, Randy Atlas, Dorisann Rinaldo, Alan Altheim, Donna Troisi, Jeanne O'Leary, Rita Demers, Donna Martin, June Feldman, Amy Clampitt, Catherine Nicolas. NORTH CAROLINA: Terry Trotter. NORTH DAKOTA: Franklin Van Osdel. OHIO: Faye Ickes, Rod Hoffman, Matilda Courey, Marie Fenley, Timothy Miller, William Braislin, Janet Hoffmann, Susan Michelson, Helen & Richard Engdahl, Juanita King. OKLAHOMA: Gene Halverson, Jean Tanner. OREGON: Judy Sedacca, Maurice McCann, Tom Hashizume, Charlotte Shupert, Edythe Allen, Gene Sigfrid, Elizabeth Shane, Scott Moreland, Paul Boehler, Mr. & Mrs. George Krieger, Bernd Crasemann, Hilda Hochhalter, Robert Stokes, Martha Hogensen, Elmer & Darlene Griser, Dr. John Chester, Velma Nicholson, Dorothea Radel, Kyle Gray, Theodore Norton, Bill & Sue Anthony, Lois Jensen. PENNSYLVANIA: Miriam Kring, Barbara Chant, Nancie Stupp, Robert Barancik, Charles Batzig, Wendy Schoenewald, Berenice Brown, Louise Blumenstein, Dr. James Martino, Neil Hopkins, Monica Marwah, Doris Africa, Frances Gilbert, Fred Fleischauer, Miriam Kring. PUERTO RICO: Patria Echevarria. RHODE ISLAND: Diane Chece, Louise Bottone. SOUTH CAROLINA: Eugenia Hughes, Saundra Sharp. SOUTH DAKOTA: Dolores Shanks. TENNESSEE: Joella Peirce. TEXAS: Dorothy Bering, Gale Robertson, Helen Barr, David Bloomer, Beckie Simpson, R.P. Burnett, Stayton Bonner, Dorothy Guthrie, Milton Sellars. UTAH: Priscilla Davidson. VIRGINIA: Linda Allen, George McAtee, Robert Hay, Arthur Demerse, June Battaile, Dr. James Laffey, Lauren Berger, Michael O'Neill, Jeanne Webb, Donna Mayer. WASHINGTON: Robert & Dorothy McNeil, Linda Paros, Charles Noble, Iola Kelly, Ann Kalberg, Ielene Edmonson, Teresa Nelson, Sharon Covey, Betty Novak, Betty Donnerberg, Helen Johnson, Ruth Howard, Mary Bartell, Gisela Shoda, Bernard Horn, T. Roger Billeter, Marvin Carmichael, The Williams Family. WEST VIRGINIA: George Bennett. WISCONSIN: Joan Orthober, Louise Zurawski, Charles Sommerfeldt, Maureen Boll, Elaine Fouts, Ilse Tennis, Anne Nadolny, Russell Oldenburg, Martha Recknagel, Mary Bichanich, Leonard Rochwerger, Eugene Schmidt, Dr. Steven Millen, Earl Burgan. AUSTRALIA: Maxine Jacobi. BAHAMAS: Barton Milligan. CANADA: Lydia Francis, Susan McNally, Rosemary Derbecker, Martin Smith. JAPAN: Kay Ehrhart. _________________________ ADVISORY BOARD PICKS NEW LEADER The National Deafness and Other Communication Disorders (NIDCD) Advisory Board elected Dr. Stephen Epstein to be its new chairperson at a recent meeting. The board provides policy guidance to the NIDCD, which supports research on mechanisms of balance, hearing, smell, taste, voice, speech, and language. Dr. Epstein, who replaces Geraldine Dietz Fox, is a nationally recognized specialist in pediatric otology, said an NIDCD news release.