JOHN LI, M.D.
OTOLOGY NEUROTOLOGY RESOURCES
210 Jupiter Lakes Blvd #5105
Jupiter, FL 33458
Dr. Li's Analogies (it rhymes!)
New and difficult concepts are much easier to digest when they are compared to ideas with which you are already familiar. For instance, I could explain that a color was comprised of light rays within which the electromagnetic waves have a wavelength of 520 nanometers. It is a pretty color. It is bright and bold. If you were not an optical physicist, you would still have no idea what color I am talking about. However, if I said the color was like that of grass, or emeralds, or leaves on trees.... you would understand the color green! For this reason, Dr. Li tends to explain things in analogy or parable form. The following are excerpts from an as of yet unfinished chapter Dr. Li has been working on. If it seems choppy, it is because it has been cut and pasted into this page. I hope it is understandable.
Dr Li’s analogies for Tinnitus: Tinnitus is like a damaged radio station. The inner ear transmits sound to the brain, which is like the receiver of a radio. In a perfect situation, music comes through clearly as music and silence comes through clearly as silence. However if the transmitter is damaged, the receiver can only pick up static -- which is like tinnitus.
Tinnitus is also like phantom pain. Normally, the foot sends signals to the brain, where there are receiving BRAIN CELLS that are responsible for telling the brain how the foot is feeling. Someone who has lost a leg may “feel” foot pain even though they don’t have a foot because these BRAIN CELLS are now unemployed because there is no foot. Likewise someone can “feel” noises in the frequencies or pitches of hearing that have been damaged. (frequencies that are not being transmitted properly by the damaged inner ear.)
Analogies re: Dizziness
...The balance system is extremely complex and is influenced by many factors. It is a delicately tuned system that can easily derailed. When it works flawlessly, It is very transparent. You don't need to think about balance, it just happens. Your body knows exactly where to place the foot for each step. You make minor position corrections to stay balanced on a bicycle without being conscious of these movements. It is so basic that you don't have to think about it.
...Dizziness is usually the result when that system breaks down. Everyday tasks become tiresome and difficult.
...There are many components to maintaining your balance. Intricate brain connections and nerve pathways are involved. These pathways can be left to the Neuroanatomists.
...We are mostly concerned with the components that matter. The 3 main components are the Eyes, Ears, and The whole rest of the body. (so much for narrowing things down.)
...In order for us to know where we are at any given time, we need at least 2 of the three components. One to tell us where we are, and another for cross reference confirmation.
Of course things work best if all the senses are working and correlate correct information. When one sense works improperly, it gives conflicting signals. Hence dizziness.
BPPV is triggered when a patient moves suddenly.
As an analogy, imagine that the particles are a bunch of bowling balls that accidently got in the front seat of a car and are rolling around, hitting the gas pedal and brakes intermittently while you are trying to drive. This could be quite disconcerting with the sudden stop and go when you are least expecting it. One way of getting the bowling balls back into the back seat would be to roll the car upside down 360 degrees, from its nose over onto its roof, and then back on its wheels. This would allow the bowling balls to roll over the front windshield, to the headliner of the roof, and then into the back seat where it belongs. (where there are not pedals to crash into and jolt the car around.)
Dr. Li's Twin Engine Airplane Analogy for one sided vestibular dysfunction
The inner ears have to give equal impulses to the brain to give the perception of balance. If both engines of a twin engine airplane are running at 100%, they will keep the plane flying straight.
Imagine if suddenly one engine failed completely, the airplane would swing wildly! Similarly, if suddenly one inner ear organ is damaged, you feel extremely dizzy and feel as though you were spinning wildly.
This brings us to the concept of compensation. With compensation, the brain does a phenomenal job in readjusting for the problem. Likewise, the pilot, when faced with an engine flameout, works on maintaining flight with the rudder and steering wheel. Although it sure is nice to have two engines, the plane can run on one. Patients can also run on one inner ear.
If the engine is out, the best thing to do is to fix it. = directed therapy - surgery, CRP etc.
Antivert (a inner ear tranquilizer) is like giving morphine for pain. It doesn't solve the problem, but it sure does soothe the pain. It is OK for short term use, but don't get dependent on it. -- If the pilot (the patient) is upset and nervous about flying the plane sideways because one engine is out, you can give him tranquilizers. Obviously this is not a particularly good option, especially in the long run. But if you must, a little scotch on the rocks and a calm pilot is better than one in a total nervous breakdown or no pilot at all. Remember, our brains don't come equipped with copilots. Think of tranquilizers as a stop-gap measure-- not something to use long term.
Vestibular rehab is like pilot instrument training. It teaches the pilot how to compensate for bad balance situations. It helps him learn to perform well with what he has whether it be an engine out, a bad compass or foggy visual conditions.
Fixed vs. Variable lesion vs. Complete
A fixed lesion is one that doesn't change (fixed as in static, stuck, unchanging, not repaired).
Variable lesions change without warning. Symptoms come and go, vertigo attacks are episodic.
Complete means all the way off...dead...kaput.
Say one of the engines is malfunctioning, for example at 50% capacity. As long as it stays working at 50% capacity, the pilot can make adjustments to keep the plane going straight.
If the bad engine fluctuates without warning, then smooth sailing is out of the question. The plane may yaw and spin without warning leaving the pilot to play catch-up to salvage each episode.
In these cases, if the engine can't be repaired, it is better to shut that engine down permanently rather than endure sudden violent attacks of vertigo.
This may be accomplished through surgery. The idea is to shut off all impulses coming from the damaged ear to the brain. This may be accomplished through vestibular neurectomy, labyrinthectomy or aminoglycoside perfusion.
Copyright © 2013 John Li M.D. All Rights Reserved