My Dizzy Story, Pt. 2: Vestibular Tests!

Welcome back to My Dizzy Story! By now I hope you have read Part 1, which dealt with day one…week one…month one…of what would become my new life. So where and how to pick up the story from there? The problem with recalling one’s journey through life, or part of one’s life, is that after awhile it becomes just scattered bits and pieces, anecdotes, events, etc. A skilled interviewer or biographer can pull these disparate memories out of their subject and mold them into a unified and organized chronological series of events that makes perfect, logical sense to the reader. Well, I am not a skilled interviewer or biographer. I’m just a guy with brain fog and a story to tell. But I’ll try to do my best. I will warn you now – this will be a rather long Post, but I hope you will stay with it, as I think it is worth the read!

Digression Alert!

Have you ever looked at your brain? I don’t mean like held it in your hand and pondered it, or looked in the mirror and saw it poking out your ear. If you ever have an MRI of your brain, take the disc and load it in your computer. It’s an eerie feeling. Even though you don’t really know what you’re looking at, the fact that you’re looking at YOUR BRAIN is just…macabre. I’ve looked at other body parts of mine from the same perspective and didn’t get the same feeling. There’s just something about…YOUR BRAIN….

On To The Story!

So…where was I? Oh, yes. A specialist (neurotologist), brain MRI, unpleasant testing, yada yada yada. Left off my story at my 2nd brain MRI. Well, the results were positive and negative. Positive in that I indeed had a brain, contrary to many of my words and actions over the years. Negative in that there was no scarring or other abnormalities indicative of a stroke, MS, or anything else ultra-serious that would explain my symptoms. Good news. But when you’re looking for answers, good news like that is a mixed blessing. Sometimes you just want an answer, good or bad. Seems counter to logic, but ask any vestibular patient who has spent months, or even years, looking for an answer. Good or bad, any answer will do after awhile!

ALERT! Complicated Procedures Semi-Competently Explained!

So what’s next? Well, first I need to back up (see the first paragraph, above). The VERY FIRST test I had was the Epley Maneuver, performed a couple times by the audiologist at my ENT’s office. The main reason I bring this up, is because it addresses what is probably the most common reason for dizziness or vertigo, especially in older adults, as (ahem) I know many of us are. The Epley Maneuver is a series of head movements designed to relieve the symptoms of Benign Paroxysmal Positional Vertigo, or BPPV. BPPV is when the calcium carbonate crystals in your inner ear become dislodged, causing disruption to the fluid that detects head motion, thus causing false signals to be sent to the brain. I’m not going to discuss the Epley more than this, but chances are you know someone who sees a Physical Therapist for the Epley or a similar test at least a couple times a year.

Anyway, life would have been so much easier if this (the rocks in my head, as I called it) was my problem, but nope, no such luck. The Epley made no difference. Thus the need for the unpleasant tests, starting with the MRI(s). A brain MRI is no picnic, especially if you are even mildly claustrophobic. But I think I’d take a blissfully semi-tranquilized MRI over another VNG/ENG/Caloric Test and Rotating Chair. Yes, Rotating Chair. Sounds like a torture device.

Next Up: The VNG!

A VNG (videonystagmography) is designed to measure the vestibulo-ocular reflex (VOR), which basically acts to stabilize your gaze when your head moves. You move your head to the right, your eyes move to the left as compensation. And vice versa. Helps maintain your balance and equilibrium, and allows you to see things clearly as you are moving. Great!

To test this reflex, the tester (usually an audiologist, but I will refer to them, just for fun, as the “proctor”) has you sit in a completely dark room wearing a pair of ill-fitting, heavy goggles. Your first thought is, “I’ll bet this is attractive!” These goggles have built-in cameras that record your eye movements. Lights move on a light bar and you follow them. Easy! Fun! The “proctor” (ahem) positions your head in different ways. You watch the light bar. Still easy and fun! Maybe they have you watch a moving object on a screen. Still easy and fun! But what does all this mean? Well, what this part of the VNG is designed to do is determine the health of your VOR, which will hopefully help to diagnose why you have dizziness, vertigo, etc. It can also diagnose nystygmus, which are involuntary eye movements, which many times accompany vestibular disorders.

But Wait, There’s More!

So far, so good. Painless, maybe a tad uncomfortable due to the goggles, or maybe the moving lights made you dizzy or uneasy. Now comes the fun part, the Caloric Test! (FUN FACT! The physician who developed this test, Robert Bárány, received the 1914 Nobel Prize in Medicine for discovering this test – he was irrigating out ear wax (love this terminology – “irrigating”) and observed how his patient’s eyes went different directions depending on the temperature of the water.

Simply, warm water is “introduced” to the ear. You’re thinking, “Well how do you do” as you’re being “introduced” to the warm water, which is actually kind of soothing, in a way!” Or maybe that’s just me, Mr. Sunshine.

Then they repeat the test by “introducing” cold water to the ear. Holy Moly! No “How do you do” here! It’s more like a fire hose is being shoved in your ear and water is blasted into you at the same pressure used for sand blasting. Okay, so maybe it’s not that bad, but it seems that way when you don’t know what to expect the first time it’s done to you. In fact, the water pressure isn’t much at all, but it is pretty darn uncomfortable.

Anyway, while this assault is occurring (warm and cold in both ears), the “proctor” is asking you to do some inane task to keep your brain functioning, like “count down from 100 by 3s,” or, my favorite, “name an animal for each letter of the alphabet.” I recall shouting in exasperation, “There’s no animal that starts with ‘Q’!!”, like it’s a real test, or something. Oh, did I mention that you’re still wearing those ultra-comfortable lightweight goggles while your ears are being violated? So not only is water being “introduced” to your ear (“How do you do, Mr. Fire Hose?), but you’re lying there in the dark. Your brain is really going into hyper-drive trying to figure all of this out.

If You Think That Sounds Bad…

So yes, the Caloric Test is pretty unpleasant. But I’ll tell you, by the 3^rd or 4^th time, you’re a pro! You figure there’s nothing that could be worse than this! But you’re wrong!

The last Caloric Test I had was ordered by a highly regarded, renowned physician at Ohio State, who insisted that I have the test with – ICE WATER! Really?? It was painful as the dickens, and from what I have read, the results are no better than those using cold water! (I’m not going to mention the doc’s name, but it might have been Dr. Sadist….) I think my heart stopped several times during that test, it was really bad.

So why go through all of this? Actually there’s a darn good reason. The Caloric Test is the best way to determine if there is damage to your Vestibular Nerve, which I’m sure all of you read about in my previous Post entitled – Vestibular for Dummies! Cold water should cause nystagmus, which would cause your eyes to move away from the ear and slowly back. Warm water should cause your eyes to move toward the ear and slowly back. Your eyes say – cold:bad; warm:good. If your eyes don’t do this, there is damage to your vestibular nerve. Voila!

There you have it! In my case, every time – 4? 5? – I don’t remember anymore, my left ear reacted pretty normally to the various assaults. My right? Nada. No response to any of the stimuli. This meant that the nerve that should have been reacting was damaged or destroyed. Some folks have what is called a bilateral weakness, where there is damage to both sides. As I always say, I count my blessings, and I am one of the lucky ones.

It Surely Can’t Get Any Worse, Can It?!

The Rotating Chair. AKA The Rotating Medieval Torture Chair. Ordered by Dr. Sadist, of course! Same day as the ice water Caloric Test. Best Day Ever! Sounds as horrible as it is. Once again you get to wear those comfy goggles, but this time you get to be strapped onto an extra comfy audiologist-type chair, situated in a pitch-dark little booth (claustrophobic anyone?). I don’t remember a lot about it at this point, so I’m relying on what little I do remember coupled with research I’ve done. First up, you sit there, again, in the dark with googly goggles, watching as lights move around, circling around you, mimicking rotation. I recall there were then a couple other similar tests, but I’ve looked at lots of moving lights with the previous tests, so been there, done that, so far so good. Not dizzy, not nauseous, this is easy!

But then the “proctor” tells you, “only one more test, and this one may make you feel queasy….”. Not being one who typically suffers from motion sickness, I’m thinking “bring it on, buddy!”. Ahem. Yep. This time the light doesn’t move, and I’m supposed to keep watching it. The chair starts rotating, and I’m spinning so fast I’m probably about to break the space-time continuum. Really! At least it seemed like it at the time! And yes, I’m feeling very, very queasy. Like put my head between my knees queasy. And it’s over. Last. Test. Ever. Dr. Sadist looks at the results – ice water, rotating chair, and basically says, “I concur with your previous physician, you have Vestibular Neuritis!” Well, duh, I already knew that. Thanks a bunch.

I should mention, in case there is an actual knowledgeable person reading this, that I think the chair was rotating. I seem to remember the “proctor” telling me that it wasn’t actually moving, that it just felt like it. But I have read that it does indeed move. Perhaps there are both kinds of “rotating” chairs. Regardless, it felt like I was spinning uncontrollably.

You’ve Passed The Test(s)!

So these are the tests to which you are subjected if you are suspected of having a vestibular disorder. And you know, they’re really not that bad in the great scheme of things. I just kind of had some fun with them here. It’s easy to do when they are years behind you, and you probably will not have to go through them ever again. However at the time they’re not so fun. As with any chronic illness, it takes time and testing to determine a diagnosis and a subsequent treatment plan. There will be frustration and discomfort, and perhaps some pain along the way, but eventually all of that will be in the past, and your new, normal life, will become your best life. Live it to the fullest!

I know this was a long Post, and I thank you for hanging in there with me.

Until Next Time, Thank You for Your Support!

Paul