At the UC Neurosensory Disorders Center, our experts provide state-of-the-art diagnosis and treatment for patients suffering from many different types of disorders of the senses.
Click to expand a topic and learn more and the treatment and services available for neurosensory disorders:
During the initial evaluation and work-up the patient will have a series of blood work completed. Through the blood work, it may help determine the underlying cause for the patient’s airway disorder. The following is the required blood work for the new airway patient: Canca, Panca, Sedimentation rate (Sed Rate), complete blood count (CBC), urinalysis, Thyroid Stimulating Hormone (TSH), Chemistry panel, Rheumatoid factor, antinuclear antibodies (ANA), Hemoglobin A1C.
Many airway disorders can affect one’s ability to speak properly. Prior to any formal airway reconstructive procedure, the patient will be seen by one of our staff Speech Pathologists who will perform a voice evaluation. This evaluation will fully evaluate the patient’s speech and swallowing mechanism.
The majority of patients who present with airway disorders either have been diagnosed with gastric reflux disease (GERD) or have symptoms of GERD. It is well documented the airway symptoms are worse in those patients with GERD.
During the initial airway evaluation, those patients with GERD or suspected GERD will be sent to a gastroenterologist for evaluation and treatment. The patient will undergo an endoscopy with pH or impedance probe monitoring.
On occasion if it is felt by the surgeon the patient is at a high risk for complications undergoing an airway reconstructive procedure due to the patient’s obesity, they may be referred to a weight loss management program. This may include both surgical and non-surgical management for weight loss.
Microlaryngoscopy, Bronchoscopy (MLB)
To fully evaluate and plan for a formal airway reconstructive procedure the patient will have an MLB. The patient is brought to the operating room and put to sleep. During this procedure, the entire voice box and airway is evaluated including taking measurements and sizing the airway. This procedure normally will take less than half an hour.
Serial balloon dilations, Cricotracheal/Tracheal resections (CTR) (TR)
Upon completing a diagnostic evaluation and MLB, a treatment plan is developed. Treatment plans range from simple serial balloon dilations to Cricotracheal/Tracheal resections (CTR) (TR).
Typically, patients with Idiopathic Subglottic Stenosis will first undergo repeated balloon dilations to provide temporary relief for their breathing difficulty. However, over time, more frequent dilations are necessary to relieve symptoms. Ultimately, a CTR or TR is often performed to fully remove the diseased portion of the trachea. Once a CTR or TR is performed, the trachea usually returns to normal.
For patients with a Tracheal Stenosis resulting from trauma or a tracheotomy, which can narrow the trachea as it heals, a TR is often needed to correct airway deformities.
ABR – Auditory Brainstem Response
The Auditory Brainstem Response (ABR) is an objective test used to identify neurological abnormalities of the auditory nerve and auditory pathway to the brainstem or to estimate hearing sensitivity.
Electrodes are placed on the patient’s forehead and behind the ears. Earphones are placed in the ears, and a click stimulus is sounded. The patient does not respond, but remains seated in a recliner as relaxed as possible. The electrodes measure the electrical activity from the auditory pathway to the brain. As the responses are recorded, they are analyzed by a computer and translated into a waveform pattern. The different peaks on the waveform provide information about the time it takes various structures of the auditory pathway to respond to the stimulus. This information can help in identifying potential causes of hearing loss or sensitivity.
ECoG – Electrocochleography
The electrocochleography (ECoG) test is an objective measure of the electrical potentials generated in the inner ear as a result of sound stimulation. Electrodes are placed on the patient’s forehead and in the ear canal. An earphone is placed in the ear canal along with the electrode, and a click stimulus is sounded. The patient does not respond to the sound, but remains seated in a recliner and as relaxed as possible.
As the responses are recorded, they are analyzed by a computer and translated into a waveform pattern. The amplitude ratio of the different peaks provides information that will help determine whether the cochlea (inner ear) has an excessive amount of fluid pressure. Excessive fluid pressure can cause a feeling of aural fullness (ear pressure), dizziness, tinnitus (noises in the ear), and/or hearing loss. These symptoms may be the result of certain inner ear pathologies such as Meniere’s disease or endolymphatic hydrops.
Hearing Loss Rehabilitation
Treatment options for hearing loss include medical treatment of acute infections; stabilization of certain disease processes such as Meniere’s disease; reconstructive surgery to rebuild the tympanic membrane or the ossicular chain; and hearing amplification or direct neural stimulation. Bone Anchored Hearing Aid (BAHA) implantable hearing devices are an option for patients with single-sided deafness and those who are unable to wear hearing aids because of prior surgery. Cochlear implantation is now a routine treatment option for patients with profound hearing loss, including congenital deafness, in both ears. The safety and success of cochlear implants has led to broader criteria for use, from infants as young as six to twelve months old to elderly patients in their 80s and 90s.
Hearing aids can’t help everyone with hearing loss, but they can improve hearing for many people. The components of a hearing aid include:
- A microphone to gather in the sounds around you
- An amplifier to make sounds louder
- An earpiece to transmit sounds to your ear
- A battery to power the device
The louder sounds help stimulate nerve cells in the cochlea so that you can hear better. Getting used to a hearing aid takes time. The sound you hear is different because it’s amplified. You may need to try more than one device to find one that works well for you. Most states have laws requiring a trial period before you buy a hearing aid, making it easier for you to decide if the hearing aid helps.
Hearing aids come in a variety of sizes, shapes and styles. Some hearing aids rest behind your ear with a small tube delivering the amplified sound to the ear canal. Other styles fit in your outer ear or within your ear canal
Vestibular rehabilitation can offer relief of symptoms for persons suffering from an inner ear disorder. Vestibular rehabilitation is an exercise program designed by specially trained therapists to help people compensate for a loss or imbalance within the vestibular system.
The program may include balance activities and/or eye or head movement exercises. The balance activities help people maximize the use of the remaining vestibular function, their sight, and the sensation in their feet to keep their balance. When there is an imbalance in the vestibular system, a person may also experience dizziness because the reflexes that help with eye movement have been changed. The eye exercises help the brain relearn these reflexes. Because each patient’s symptoms and needs are different, it is very important to design a program to meet individual needs.
Fall prevention is a very important part of vestibular rehabilitation. Even if testing shows that someone suffering from imbalance does not have a vestibular disorder, he or she may be referred to vestibular rehabilitation for fall prevention. Conditions other than vestibular disorders which may cause imbalance are poor eyesight, poor sensation in the feet or weak leg muscles. A balance aid such as a walking stick may be all that is needed to help people maintain their balance and prevent injuries from falling. Patients may also be referred to an occupational therapist to discuss home safety and assistive devices. The goal is to prevent patients from falling and keep them independent and safe.
Testing and treatment techniques to aid patients suffering from facial paralysis disorders are designed to reinforce proper eye care, improve facial symmetry at rest and during function, improve oral stage swallowing increase speech intelligibility, and/or reduce abnormal tone and unwanted movement.
- Nerve Excitability Test (NET)
- Maximal Stimulation Test (MST)
- Electroneurography (ENoG)
- Electromyography (EMG)
- Electrical Stimulation
- Individualized Home Practice Programs
Surgical techniques can be used to tailor the best procedures to treat facial paralysis and improve appearance.
Botulinum is sometimes utilized to decrease abnormal facial movement (synkinesis, or “abnormal cross-wiring,” of the nerves) for patients.
Neuromuscular Retraining and Oral-Motor Techniques
Medical techniques such as neuromuscular retraining and oral-motor techniques can be used to help diminish paralysis and improve facial muscle and oral control.
Facial rehabilitation modalities are utilized to optimize facial muscle tone to improve facial symmetry and strength, as well as to reduce involuntary facial movements caused by synkinesis.
Eye care reinforcement correction strategies for preventing corneal abrasion, gold weight placement to upper eyelid, possible tarsorrhaphy, and lower eyelid tightening.
Surgical Facial Reanimation
Surgical facial reanimation procedures can be successful in increasing lower facial support and movement.
Combined Retraining and Feedback Therapies
By combining oral-motor and neuromuscular retraining approaches, mirror feedback, and biofeedback, some patients can increase ROM, strength and/or decrease synkinesis.
Barium swallow is an x-ray to examine the esophagus using liquid barium. The liquid barium is a white liquid, mixed with water, which the patient drinks. Liquid barium helps the esophagus show up better on the x-ray. The barium swallow test will show what is causing painful or troubled swallowing to ensure proper diagnosis and treatment.
Flexible Endoscopic Evaluation of Swallowing (FEES)
A FEES evaluation helps determine why a patient is having difficulty swallowing. A thin, flexible wire is inserted through the nose to look at your throat as you swallow. The physician or speech pathologist will be able to see the base of your tongue and vocal cords to too see whether foods are passing through correctly or whether you are at risk for aspirating. Certain foods are used during a FEES with different textures and consistency, along with food dye to track. If certain foods have been causing you problems, you are asked to bring those specific foods to the evaluation.
The transnasal esphagoscopy is a thin, flexible wire with a miniature digital camera at the end of the tip that is inserted through the nasal cavity and down the throat to capture your swallowing techniques. The transnasal esphagoscopy requires no sedation or additional medications. Like the FEES and Barium Swallow, this test captures your swallowing habits. However, it is less invasive and requires no medication or hospital stay.
Many swallowing disorders can be treated with medication. Drugs that slow stomach acid production (proton pump inhibitors), muscle relaxants, and antacids are a few of the many medicines available. Treatment is customized to the particular cause of the swallowing disorder.
Patients suffering from swallowing disorders can also benefit from dietary therapy. These include:
- adopting a bland diet with smaller, more frequent meals
- eliminating alcohol and caffeine to reduce weight and stress
- avoiding meals or snacks within three hours of bedtime
- elevating the head of the bed while sleeping.
Taking antacids between meals and at bedtime may also provide relief if the changes listed above are unsuccessful.
Direct Swallowing Therapy
Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or restimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.
Surgery is used to treat certain problems. If a narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or even released surgically. This procedure is called a myotomy and is performed by an otolaryngologist-head and neck surgeon.
Scratch and Sniff Test
The scratch and sniff test is an easily administered, sensitive and reliable test used to detect smell disorders. The test uses different tastants such as sweet, sour, bitter and salt solutions to provide a whole mouth evaluation.
Sometimes, smell or taste disorders are caused by certain medications and often patients will notice improvement by simply changing medications or stopping altogether. While certain medications can lead to chemosensory problems, others—like anti-allergy drugs—can have the opposite affect by improving taste and smell senses. In other cases, patients experiencing serious respiratory infections or seasonal allergies often regain their smell or taste once their illness has run its course.
Often, loss of smell and taste can be corrected by restoring airflow to the receptor area through the removal of nasal obstructions like polyps. In other cases, chemosenses return to normal just as spontaneously as they were lost.
A patient who experiences an onset of unexplained facial pain typically visits his or her primary care physician or dentist. If a dental problem is ruled out, the patient should then be referred to a neurologist or neurosurgeon for further evaluation. A CT or MRI scan should be performed to rule out the possibility of multiple sclerosis or a tumor. A diagnosis is made after a careful assessment of the patient’s symptoms.
The first line of treatment for trigeminal neuralgia involves medication, including anticonvulsants, which block firing of the nerve, and muscle relaxants. Medications will provide a long-term solution for about 25 percent of patients with trigeminal neuralgia. Patients who do not achieve long-term pain relief from medications, or who develop unacceptable side effects, may become candidates for surgery.
Microvascular Decompression (MVD)
Microvascular decompression, or MVD, is a surgical procedure in which the surgeon makes an opening in the back of the skull and frees the nerve from the abnormality that is compressing it. The procedure is effective for 95 percent of patients and causes little or no facial numbness.
Percutaneous Stereotactic Radiofrequency Rhizotomy (PSR)
Percutaneous stereotactic radiofrequency rhizotomy, or PSR, is a minimally invasive procedure in which a hollow needle is inserted through the cheek and into the trigeminal nerve at the base of the skull. The neurosurgeon uses an electrode to destroy the portion of the trigeminal nerve that is causing pain. The procedure is immediately effective for 99 percent of patients. Symptoms will recur in about 15 percent of patients within 10 years. This subset of patients can be treated with medication, another PSR, or a different surgical procedure. Side effects include partial numbness in the area that was treated.
Percutaneous Glycerol Rhyzolysis
Percutaneous glycerol rhyzolysis is a minimally invasive procedure in which a hollow needle is inserted through the cheek and into the trigeminal nerve at the base of the skull. The neurosurgeon injects glycerol to damage the portion of the trigeminal nerve that is causing pain. The procedure is immediately effective in about 70 percent of patients, but symptoms will recur in 50 percent of patients in three to four years. Side effects include partial numbness in the area that was treated.
Percutaneous Balloon Compression
Percutaneous balloon compression is a minimally invasive procedure in which a hollow needle is inserted through the cheek and into the trigeminal nerve at the base of the skull. Using a narrow catheter, the neurosurgeon places a balloon inside the trigeminal nerve. Once inflated, the balloon compresses and damages the portion of the nerve that is causing pain. The balloon and catheter are then removed. The procedure is effective in about 80 percent of patients, but symptoms will recur in 20 percent of patients in three years. Side effects include minor numbness in the area that was treated.
A neurectomy involves the cutting of the trigeminal nerve or one of its branches. A treatment of last resort, a neurectomy results is irreversible and results in permanent numbness of the region of the face that the nerve supplies. A neurectomy may be performed during an microvascular decompression if the neurosurgeon cannot find a vessel or other abnormality that is compressing the nerve.
Stereotactic radiosurgery is a noninvasive outpatient procedure in which precisely targeted beams of radiation are used to destroy a portion of the trigeminal nerve.
Flexible Fiberoptic Laryngoscopy
Flexible fiberoptic laryngoscopy is the most common type of examination used to visualize the areas of the throat and voice box. The exam uses a thin, flexible endoscope containing fiberoptic cable that can be manipulated to examine areas not normally seen by traditional examination techniques. The endoscope is inserted through the nose and passed into the throat under direct visualization. Most patients tolerate this examination without much difficulty.
Laryngeal Electromyography (LEMG)
Laryngeal electromyography (LEMG) is a test that gives information about the motor activity within the tiny muscles that control the vocal cords. This information is not available by any other test. This activity is important because it has implications for diagnosis and for predicting recovery of function. Diagnostically, LEMG is essential in determining the neuromuscular status of the vocal cords. Subtle weakness in the vocal cords may not be seen on endoscopic examination and may only be evident after an LEMG is performed. In cases of vocal cord motion impairment, LEMG can effectively distinguish vocal cord paralysis from impairment caused by scarring.
Laryngeal Sensory Testing
Sensory testing involves passing a thin, flexible endoscope through the nose to cause an airway protective reflex. Decreased or absent sensation can cause aspiration (food to go into the trachea instead of the esophagus).
Rigid Transoral Laryngoscopy
Rigid transoral laryngoscopy is one type of examination used to visualize the voice box. The examination utilizes a rigid endoscope (device used to examine internal structures) to visualize the vocal cords. The endoscope is inserted into the back of the mouth. It has an angled lens, which allows the physician to look down at the vocal cords. This examination results in a magnified view of the vocal cords with high image quality. It is best for studying abnormal growths on the vocal cords. Without stroboscopy, this technique cannot evaluate the vocal cord vibrations.
Speech therapy is often prescribed for patients with certain voice disorders. It is a form of treatment in which a therapist analyzes the way a patient uses his or her voice and attempts to correct abnormal speech patterns through vocal exercises. These abnormal patterns promote worsening or prevent resolution of certain conditions that may affect the voice. Elimination of these may help to cure the disorder.
This is like rigid transoral laryngoscopy, except that a strobe light is used instead of a constant light. This allows evaluation of the vibrations of the vocal cords during phonation.
A voice evaluation involves a series of tests designed to analyze the voice and help determine what is wrong. The voice evaluation is designed around the patient’s problem and may last only a few minutes. Evaluations for complex voice disorders can last an hour, especially if the voice therapist is evaluating the patient for different forms of therapy.
Vocal Cord Cancer Evaluation
This involves a careful history and a head and neck exam. Evaluation of the vocal cords is usually done by flexible fiberoptic laryngoscopy or by rigid transoral laryngoscopy. The addition of stroboscopy can be helpful, depending on the location and extent of the disease. This evaluation can identify masses or lesions suspicious for vocal cord cancer. However, a biopsy is needed to definitively diagnose this condition.