A Dizzying Condition A months-long battle with the effects of a facial nerve virus gives one SLP a unique perspective on treatment modifications for people with vestibular disorders. First Person/Last Page
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First Person/Last Page  |   July 01, 2017
A Dizzying Condition
Author Notes
  • Kristina Peterkin, MS, CCC-SLP, is an assistant professor in Creighton University’s School of Pharmacy and Other Health Professionals in Omaha, Nebraska, and a clinician in its pediatric therapy clinic. She is an affiliate of ASHA Special Interest Groups 13, Swallowing and Swallowing Disorders (Dysphagia); and 17, Global Issues in Communication Sciences and Related Disorders. tinapeterkin@creighton.edu
    Kristina Peterkin, MS, CCC-SLP, is an assistant professor in Creighton University’s School of Pharmacy and Other Health Professionals in Omaha, Nebraska, and a clinician in its pediatric therapy clinic. She is an affiliate of ASHA Special Interest Groups 13, Swallowing and Swallowing Disorders (Dysphagia); and 17, Global Issues in Communication Sciences and Related Disorders. tinapeterkin@creighton.edu×
Article Information
Balance & Balance Disorders / Special Populations / First Person/Last Page
First Person/Last Page   |   July 01, 2017
A Dizzying Condition
The ASHA Leader, July 2017, Vol. 22, 72. doi:10.1044/leader.FPLP.22072017.72
The ASHA Leader, July 2017, Vol. 22, 72. doi:10.1044/leader.FPLP.22072017.72
The speech-language pathologist in me wondered why I had such a poor lip seal while drinking my coffee one Sunday morning. I was on antibiotics for a piercing earache, but a look in the mirror confirmed my inkling that something else was amiss.
The right half of my face drooped and refused to move. It stared back at me with no blinks, no smile, no eyebrow movement and no wrinkles. A stroke? Bell’s palsy? My thoughts raced as I checked that I could make fists with both hands. An emergency room visit and a diagnosis of Bell’s palsy later, I thought I was in the middle of one of life’s speed bumps. Little did I know that I had a rare disease, Ramsay Hunt syndrome—a shingles outbreak in my facial nerve—that would turn into a neurological nightmare that would last for months.
Phase two of my journey with Ramsay Hunt began about 20 days after my initial paralysis. My hair a wild mess and an emesis basin on my lap, I pleaded with my otolaryngologist to make the spinning and roller coaster stop. I had been through 48 hours on the bathroom floor vomiting and attempting desperately to sleep. I had to crawl down the steps the day of my appointment. One look at me, and the nurse grabbed a wheelchair.
My audiologist administered the Dix-Hallpike maneuver to determine the cause of the vertigo (inner ear or brain). I desperately hoped I would not vomit on his shoes. Surprisingly, I felt about the same as he administered the test. My affected eye would not stop moving. I had nystagmus. There was no quick fix and it was not a positional problem. I needed a comprehensive clinical vestibular/balance evaluation.
The warm water poured into my affected ear during the videonystagmography testing—which should have made me feel dizzy and out of balance—felt soothing. Results showed that I had lost 81 percent of my balance in my affected ear, had a sensorineural hearing loss, and had significant visual-perception difficulties. I needed vestibular therapy for the next four months. I could not drive for weeks, walked with a cane for months, and was on medical leave for five months.
Ramsay Hunt syndrome affected my facial, vestibulocochlear and auditory nerves, but also left me with a unique perspective for treatment modifications for patients with similar needs:
  • Listen to your patients as they share their perspectives.

  • Recognize that visual and vestibular-perception issues often result in some anxiety as the patient relearns how to navigate their environment.

  • Be aware of your treatment environment: the glare off the floor or long hallways, for example, or stimuli behind the patient or in their peripheral view.

  • Remind your patient to use their breath to regain balance and perception.

Last, remember the life-changing impact your treatment provides.
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FROM THIS ISSUE
July 2017
Volume 22, Issue 7