Has there been an increase in the number of patients with balance disorders during the pandemic period?
Yes, especially some of our patients came with the complaint of dizziness after suffering from COVID-19. As we know, COVID-19 is a viral infection. Some viral infections cause balance disorder. It was inevitable for those who had COVID-19 infection to experience severe dizziness and balance problems. As a result, the pandemic resulted in an increase in the number of patients.
Lecturer Ayşe ÖZER said that they performed Videonystagmography (VNG), Caloric test, Postural and Cerebellar tests, Vestibular Evoked Myogenic Potentials (VEMP) tests in detail in the clinic. She stated that before beginning the test, they took a detailed anamnesis from the patient. After wearing infrared glasses, the patient is placed in the proper position. The procedure for taking the test is explained, and the test begins. During the test, it is determined whether there is nystagmus by looking at the eye movements of the patient. In this way, they determined that the balance disorder was of peripheral or central origin. She recommends that if she/he is taking vertigo medication, she/he should stop taking it 3 days in advance, put on comfortable clothes, and consume light foods before coming to the clinic.
Which complementary tests do you use? How do you interpret the tests? What are your recommendations to patients after the test?
The tests we do vary according to the disease. One test alone is not enough. They are all complementary to each other. In addition, as a complementary test, imaging methods such as MRI, CT, Doppler help us making the diagnosis. E.g; For Meniere's disease, caloric and pure tone audiometry must be performed together with the VNG test, or to diagnose Superior Semicircular Canal Dehiscence (SSKD), VEMP, pure tone audiometry, and especially acoustic reflexes must be examined in addition to the VNG test. After performing all the tests, we make some recommendations to the patients according to the diagnosis. Recommendations differ according to the disease. For example, if you have a diagnosis of Benign Paroxysmal Positional Vertigo (BPPV), avoid sudden movements, and in Meniere's disease, we can recommend not consuming salt or caffeine.
Providing information about the vestibular system lessons in audiology undergraduate education, Res. Asst. Azize Köseoğlu:
“Audiology program students after entering the vestibular system theoretically and practically with the “Vestibular System Diseases and Evaluation Methods” courses in the first semester of the 3rd year. Then they learn vestibular rehabilitation methods and preparing a vestibular rehabilitation program with the “Vestibular Rehabilitation” course in the second semester of the 3rd year,” said.
After saying that they can perform VNG, Video Head Impulse Test (v-HIT), Caloric tests from vestibular tests in the Audiology Laboratory of the Faculty of Health Sciences of Istanbul Gelişim University, she gave information about the tests:
Videonystagmography (VNG) is used to test inner ear and central motor functions. It is used to determine the causes of dizziness, balance disorder and other disorders related to balance.
The VNG test records and monitors nystagmus, which is involuntary eye movements. Infrared glasses are used to monitor eye movements during visual stimulation and position changes. Vestibular and oculomotor system abnormalities are determined with VNG. The audiologist effectively evaluates the patient with "vertigo", objectively measures, video records, and documents abnormal eye movements caused by Benign Paroxysmal Positional Vertigo (BPPV), Vestibular Neuritis, Internuclear Ophthalmoplegia (INO), and other peripheral and central neurological pathologies.
Caloric test: In the caloric test, temporary and short-term dizziness is created by inserting cold and hot caloric stimuli (air and water) into the ear canal. The resulting bioelectric activity and nystagmus in the eyes are recorded with video, documented, and interpreted. The caloric test measures the parameters of vestibular hypofunction and directional preponderance. The Video Head Impulse Test (v-HIT) is a test in which the vestibulo-ocular reflex is evaluated objectively. It provides an objective evaluation of the covert saccades. Test time is short (5-10 minutes) and video recording is taken.
During the COVID-19 pandemic, the number of patients with balance disorders has increased. However, the awareness of audiologists on this issue and the early use of tests for the diagnosis of balance problems contribute positively to the course of treatment by ensuring the early diagnosis of our patients.
