Did You Know: Focusing on Vestibular Disorders in Audiology
Can you tell us what led you to specialize in vestibular audiology?While I was a junior during undergrad, I attended a Student Academy of Audiology meeting at which Dr. Christopher Zalewski was the guest speaker of the night. We had barely covered any vestibular topics during my undergrad audiology courses, and Dr. Zalewski decided to give us a brief preview into the world of vestibular diagnostics. He showed us sample videos of nystagmus during rotary chair testing, BPPV treatments, and so much more that really opened my eyes to the endless possibilities that the audiology field could lead me to. As I learned more about this speciality once I began grad school, I loved the more medical aspects of the field that could be utilized in a holistic approach to patient care.
How do you tailor treatments to individual patients, given the complexity of vestibular disorders?
Treatments for vestibular disorders are very dependent on the etiology of the condition and the affected organs. For cases like that of Benign Paroxysmal Positional Vertigo (BPPV), many individuals may believe that everything can be fixed by simply performing an Epley Maneuver. However, some of those individuals don't take the time to investigate which specific positions an affected patient experiences vertigo in and which positions you as a clinician observe a specific nystagmus pattern in. Simply doing an Epley isn't going to fix someone with horizontal canal BPPV. More complex vestibular disorders like neuritis might not simply be fixed with a patient performing left and right head turns while seated and reading words on an index card. They may have affected otolith organs and subsequent ambulatory concerns that require more dynamic and active vestibular rehabilitation protocols. Collaborative efforts are also key to treatment. If a patient has suspected vestibular migraines, for example, you're going to want to make sure that they are following up with a neurologist as well as possible vestibular rehab should their symptoms persist after medical management.
What are the biggest challenges you face in your work?
It is sometimes difficult to stress the importance of many vestibular diagnostic tests. Many healthcare providers continue to see vestibular diagnostics through the "VNG lens" without realizing that there are many tools at our disposal that can assess the entire vestibular system to pinpoint more accurate diagnoses that will lead a patient to more effective treatments. Once a complete vestibular diagnostic test battery becomes the standard of care for dizzy patients, we as a field may begin to see more satisfied individuals seeking care with fewer pit stops along the way.
Are there any emerging trends or new treatments in vestibular audiology that you find promising?
A more prevalent focus on specific sites of lesion when it comes to treatment of vestibular disorders seems to be shining a light on vestibular audiology. This includes more research opportunities when it comes to topics such as otolith dysfunction or vestibular implantable devices to address bilateral vestibular dysfunction. These topics could lead to a more streamlined approach to treatment that may be similar to treatment options that already exist for hearing disorders (i.e. cochlear implants).
What do you see as the future of vestibular audiology in terms of treatment and technology?
I hope that the future of vestibular audiology and audiology in general will consist of all audiologists implementing a vestibular screening tool into their everyday test battery, as many patients we see may be at risk of falls or have comorbid vestibular disorders. I hope that other healthcare professionals treating vestibular patients (i.e. physical therapists) will take into account diagnostic testing before, during, and after treatment in order to monitor progress of rehabilitative techniques and be able to modify treatment protocols based on this. I hope that there will be technological advances to allow for more comfortable testing methods that patients endure so that they may not be deterred by a vestibular test battery. I also hope that these technological advances make vestibular diagnostic equipment easier to use as to not deter clinicians from performing necessary tests.
Dr. Johnathon O’Neal received his Bachelor of Arts degree in Hearing and Speech Sciences from the University of Maryland, College Park and his Doctor of Audiology degree from Gallaudet University. During his time at Gallaudet, he became immersed in Deaf culture and continues to strive to learn more from the community. He also fell in love with the field of Audiology at the university, and became involved in the Vestibular and Balance Lab to further study various vestibular disorders, primarily amongst the Deaf community. He was the primary investigator for a study titled “vHIT Uses and Procedures: A Survey of Audiologists” that examined the various ways audiologists and audiology students perform and interpret the video head impulse test (vHIT). He also led a group of first year audiology students to develop a virtual vestibular screening tool for the purpose of being able to refer individuals for extensive vestibular diagnostic testing during the COVID-19 pandemic.Dr. O’Neal completed his audiology residency at the American Institute of Balance to perfect his neurodiagnostic and rehabilitation skills. Following completion of his Doctor of Audiology degree, Dr. O’Neal has worked in both private practice settings and hospital/ENT settings specializing primarily in vestibular diagnostics and rehabilitation as well as cochlear implant services.