Ear crystals and strange tests: inside a dizziness clinic

David Moody, 59, never thought he would suffer from vertigo and dizziness in his 50s.

But an accident on his 57th birthday - he slipped and hit his head, causing a brain haemorrhage - knocked his balance off for years and triggered episodes of debilitating vertigo.

“...The best I can describe it is dizziness made me feel light-headed and off-balance, standing on a rocky boat.”

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“Vertigo was much worse. It feels like the room around me is spinning and moving, and it makes me feel really like nauseous.”

He couldn’t garden. He couldn’t job hunt and earn a living. He had seen various specialists when one of them pointed him to Auckland’s New Zealand Dizziness and Balance Centre, one the few specialist centres in New Zealand to deal with all things dizzy.

The centre includes audiologists, ear, nose and throat (ENT) doctors and vestibular physiotherapists, reflecting the interplay between hearing and balance (the vestibular system includes tiny inner ear organs crucial to balance).

After two years of treatment at the clinic, Moody clocks himself at 80 percent recovered, something that seemed unimaginable in the months after his accident.

“You don’t actually think about these places until you need them.”

Research suggests about 40 percent of people will experience vertigo in their life. Instances of dizziness and vertigo increase as we age but it can be surprisingly common in middle age. Young adults and children can face it following a concussion or head injury. Anxiety can also be a trigger.

Often patients arrive at the clinic and similar centres in New Zealand after putting up with dizziness for months or years. Many patients have complex situations with treatment ongoing for years. Others come with a simple problem: ear crystals - little flakes made of calcium carbonate - that get dislodged from head trauma or something as mundane as getting out of bed.

It’s known as benign paroxysmal positional vertigo or BPPV. A vestibular physiotherapist can solve this by taking the patient through a manoeuvre that involves lying down quickly and turning your head from side to side.

“In those situations, you’ve turned their lives around and they just can’t believe how quick a change can be made through some simple techniques,” said Bronagh Quinn, a neurological and vestibular physiotherapist at the Back in Motion clinic in Dunedin.

“Quite often people think they have to put up with it, or they might have been led to believe that it'll go away on its own, and then it doesn't.

“It persists because the crystals haven't actually been moved out of the area that they shouldn't be in.”

It’s one of the treatments that has helped Moody in his recovery. However, his case is complex, requiring other solutions such as hearing aids and medication to dull ongoing, daily headaches. He referred to his head injury as invisible.

“...everybody around you can’t see it so nobody knows.”

Lisa Goulart is an audiologist treating Moody through the New Zealand Dizziness and Balance Centre. She was part of the team that opened the clinic in 2012.

“We did this for pure passion, initially, not for revenue and so we started in September and we were so busy, we never had a downtime since 2012.”

Many of the patients have dislodged ear crystals which can be treated in one or two sessions. Ideally, Goulart would like GPs and trained physiotherapists treating the condition so the clinic can focus on more complex cases.

The clinic on Auckland’s North Shore is intentionally windowless as some of the tests used to diagnose various causes of dizziness and vertigo require darkness. Patients with complex cases move through four different rooms where a battery of tests are conducted using some pretty weird equipment. Imagine James Bond going for a physical in Q’s research and development lab.

There’s a $50,000 pair of glasses with tiny cameras to assess eye movement. One of the tests involves standing in a chamber where the platform you are on tilts and vibrates, measuring how well you keep your balance under pressure.

In another room, your forehead gets knocked continuously with a rubber-tipped hammer for a minute straight. Another test alternates between blowing hot and cold air in your ear.

“In anyone who has good inner ear function, they go into vertigo. If your ears are not working, the air does nothing,” said Goulart.

She asks if I want to do the test and experience vertigo. I’m curious, but I’m also scared so I decline. I had a whirl in the chamber of destabilisation - my name for it, not theirs. It's challenging to stand on a rocking platform while closing your eyes and patients are harnessed incase they fall).

With the help of the clinic, Avalon Sanders, 55, got a diagnosis of Ménière's disease, solving a year-long mystery. Those with the disease experience vertigo, hearing loss and a ringing noise in the ear called tinnitus.

“It’s incomprehensible how the type of testing that [Goulart] did can identify that one of my organs in my inner ear system, which is called the saccule, was completely not functioning."

An MRI confirmed Goulart’s suspicion. Ménière's disease is incurable and will continue to worsen. Sanders had to hit pause on a successful real estate career because of the symptoms.

“It's really limited what I would have considered to be normal day-to-day enjoyment.”

Sanders believes finding the clinic short-tracked her diagnosis, saving her from years of bouncing around different medical specialists.

The field of dizziness is well established in the US and UK where there is a growing interest in vestibular research. It is small but expanding in New Zealand, said Rebekah Miller, a neurological and vestibular physiotherapist at Balance Works in Christchurch. She is doing her PhD in the specialty.

“When I first began in this area, it really was emerging in New Zealand. That was slightly over 20 years ago. There were very few practitioners,”

At a vestibular training event in Auckland last year, about 80 physiotherapists attended. But a weekend course doesn’t make you an expert, cautioned Miller, suggesting that patients head to the “Find a Physio” page on the Physiotherapy New Zealand website and use the search term “vestibular.”

“We just need more [practitioners] at the top of their game.”