Webinar Transcription 

Welcome everybody like as ann said tonight we’ve got Dr. Carlo Rinaudo, he’s a registered chiropractor researcher and educator he’s over 21 years of private practice and obtained clinical postgraduate training in functional neuro rehabilitation and sports chiropractic Dr. Rinaudo is the clinic director and founder of a multi-discipline clinic based in sydney um focused on helping people with a range of complex neurological conditions i myself have personally been to see Dr Carlo and he helped me greatly he has completed a phd in vestibular therapy at university of new south wales and neuroscience research australia where he continues to be an active in vestibular research pushing the boundaries on our understanding between the brain vestibular system and the human body as i said i’ve personally been treated by Dr carlo and he helped me get my confidence back on track to have health goals and aim to where i’d like to head to keep me strong and i still do many of these exercises so thank you for helping me dr carlo please welcome dr carlo okay thank you look i i jumped at the opportunity when anne asked if if i wanted to present to um to your group and i did so open heart and i think tonight i’m looking at looking forward to sharing some of my thoughts on menus and i’m going to talk about some of some of the new technology and advances that research and clinical applications are starting to uh produce with good results and i’ll obviously talk about my experience in practice as well so let’s uh so obviously a big thanks to ann and the team uh and i was uh i was pleased to see uh anita and and others uh take part in tonight so again i appreciate the opportunity to um to be here talking to you guys just a disclaimer and i guess this is important because i want to be able to set up my apologies i want to be able to set the intention of what this talk is about and what it’s not about so obviously the material that i want to talk about is really information that i’ve gathered either through personal practice research or through education it’s not to be considered or intended as providing personalized medical advice please always seek your own doctor whether it be medical allied or specialist in more advice that’s specific for you and it’s up to the discretion and the judgment of the and the sole responsibility of the recipient of the information to determine if any of the products assessment and therapies prescribed are appropriate so my talk is really going to be quite broad i’m going to outline some of the things that works for for some uh and in some instances for many uh but it may not be appropriate for yourself so the information provided should not be considered as a claim regarding any procedure or treatment and certainly some of the tests and procedures have yet to i guess pass through the rigors of validated science in terms of randomized controlled trials or pass through the rigors of what most people would consider to be best practice so some of them some of these things that i’m going to talk about are on the fringe some of them are off label and some of them are best practice and i’ll try to identify where those are so you can be best informed but really the intention of this talk more than anything else is i want you guys to think about if anything have more questions raise more questions as to particularly potentially what’s causing your conditions um i’m not here to answer everything that relates to meniere’s or in particular your condition but really i want you to think about an integrative or an holistic approach to treating meniere’s disease um and so with that if you walk away with a set of questions that you can either ask yourself or your primary health practitioner i’d be pretty happy with that um i think you know health comes from you being inquisitive and wanting to know uh learning about yourself and hopefully by the end of this season’s presentation i’ve i’ve dropped a few things that make you think about where you could be spending your energies and resources to to help you lead i guess a healthier and better quality of life so for those who don’t know i’m sure the inner ear is something that many many of you who have experienced many years um have looked at and wondered where does everything fit so very broadly hopefully this is not a this doesn’t come as a surprise to you but we’re looking at the ear we’re looking at the external ear which is obviously where we have the the ear the earlobe and the ear canal we have the middle ear which is made up of the tympanic membrane or the eardrum and the little ossicles or the bones that help transduce um uh sound into uh or airwaves into sound and then we have the inner ear and the inner ear is where i think most of us are i want to spend our energies and it’s really uh it’s broken up into two parts one of which is the vestibular apparatus and the vestibular apparatus is made up of these these semicircles three semi-circular canals and then we have the cochlea and the cochlear is where we um is used for hearing and it’s generally within years we have both these areas that are affected so both the vestibular portion which relates to our ability to detect motion and our sense of dizziness and balance and our cochlea which is involved with a sense of sound okay well the rest is just intro and anyway you’re getting a copy of these slides so don’t don’t don’t worry too much you certainly don’t have to scribble down any notes you’re getting an audio record video recording on this and also my notes as well um so yes so there’s the orientation of the ear but most of you would be familiar with it so again with meniere’s most of us would be uh would understand that it’s it’s described as a spontaneous episodic type of condition that involves a combination of vertigo or spinning sensation medium to higher frequency hearing loss tinnitus or ringing sounds and a sense of fullness or discomfort in the ear these episodes can last anywhere between 20 minutes to sometimes several days but typically 20 minutes up to several hours and it is described as a peripheral vestibular condition the importance of that i’m going to draw upon you very shortly but it’s important you understand that it’s it’s really a condition of the inner ear or at least classically it’s described as such i’m going to shake that up a little bit with some of the things that i’m going to be talking about tonight

the treatment options would be there are conservative ones and there are vestibular suppressants when when one has an attack uh stematol benzodiazepines are the most commonly prescribed most people are familiar with a low sodium diet and diuretics to help minimize these episodes and to help abate symptoms or to help minimize the severity of the dizziness and the balance issues most people have been exposed to some form of vestibular rehabilitation and lifestyle modification unfortunately for those that have intractable menieres where the condition and particularly the tinnitus aspect has persevered for a period of time or at a severe level uh corticosteroids gintamycent injection into the middle ear are likely to be prescribed and for those right at the end we’re looking at nurse sections of labradectomies as sort of the last stage uh ways to manage some of the symptoms so going back to what i was mentioning before about the peripheral peripheral aspect so just by definition when we talked about so when we talked about peripheral vestibular system we’re really referring to that inner ear that we mentioned the the organ of the inner ear as well as the nerve that connects the inner ear to the brain so that’s referred to as a peripheral vestibular part of the system central vestibular systems is not one that’s normally associated with many years but it is it is important and it really is the information that is taken from the peripheral system and it’s interpreted it’s it’s defined it passes through many filters to give us an understanding of our awareness it gives us our emotional response it gives us our cognitive response it gives us our whole body response so when we talk about central vestibular pathways we’re really talking about everything else apart from the inner ear so we’re talking about the brain or this primitive part called the brain stem um we’re talking about higher areas of the brain all these are often neglected when it comes to managing someone with a a purely peripheral vestibular condition of which meniere’s disease is one of them so any of you who’ve been to vestibular therapy or had any sort of therapy apart from pharmaceutical intervention we’ll have had therapy that’s often specific to helping the inner ear work better and maybe with some minor aspects that relate to balance and some stability but often we neglect areas that relate to our autonomic system to our spinal system to our eye movement system to our fine control systems to our cognitive systems to our memory systems to our um to our body awareness systems these are areas that i i strongly believe that if we can enhance with people with menis then i’m confident that and we’ve seen it in our office that we can improve their quality of life um and improve resilience and adaptability and they’re two words that you’ll hear me say a few times improving resilience to reoccurrence and adaptability so you’re more you have more capacity to endure and enjoy your life despite being rattled at times with some of these these flare-ups that you might have

i’m just trying to how did i navigate through this

next one

i’m just trying to work there we go okay so the role of these central networks if you think of it like a big amplifier and on an amplifier you have all these knobs and these buttons and that can adjust the volume and the pitch and the frequency and the and all these little nuances that relate to that sensory information that comes in so what the brain does essentially particularly as it relates to vestibular function is it it can adjust things it can increase the amplitude it can decrease the volume it can increase the pitch you can increase how our brain and body responds given an altered signal that comes from our inner ear think of it like a um you know you’ve got an am radio and and you want to you want to digitize it you want to make it like an a an fm quality or if you want to make it a digital quality you really need a lot of amplifiers and synthesizers that can take that information that analog fm signal um am signal sorry and you can play with it so the signal becomes clearer and your body can make and and you can make more sense of what’s coming through think of those central networks as being exactly that all these little volume knobs that are scattered throughout our brain can take that otherwise compromised auditory and vestibular input including tinnitus can change that input and make it more palatable tolerable and livable and if we can work on getting those central networks to be healthier more adaptable and as i said more resilient you can have a far greater chance in in not having those symptoms take such a burden as i know they do with many many patients so the healthier that central system is the more resilient and adaptable the body is and that’s going to be the metro through this talk because my talk is not going to be things that you’ve heard about typically with with meniere’s but rather what can we do as a whole body to get the brain and body to be more flexible more adaptable so you can generally live a more fulfilling life

try to keep some of the technical aspects of my presentation down this is probably one of the more technical question uh slides um but i’ll break it down hopefully quite uh quite nice so here’s the inner ear and we’ve got our our cochlear and we’ve got our vestibular portion so we’ve got our hearing tinnitus aspects we’ve got our vertigo based aspects that relates to the inner ear the information from this area feeds through a nerve and reaches our brain and these areas that coordinate and remember think of that that big mixer board with all the volume knobs sits in many parts of the brain we’ve got information that comes from our neck and our body otherwise known as proprioception so proprioception is a big word all it means is information that was gathered from our body and gives our brain an understanding of where it is in space we have information from different parts of our brain including our cerebellum which is really involved with fine motor control oculomotor inputs which is information that comes from our eyes our cortical inputs which information that comes from higher brain centers and these come in together in conjunction with our inner ear and gives us these three main outputs it gives us an output that relates to balance and posture it gives us an output that relates to our eyes and keeping our eyes stable and gives us an output that relates to giving us an understanding of where we are relative to space now on almost all if not every meniere’s patient that i’ve seen we see a compromise in balance and posture instability we see a compromise in vision stability and we see a compromise in our understanding of where we are relative to space now sometimes this is only prevalent when we’re having uh

hi carl just letting you know your internet’s frozen

hello can you hear me yes you’re back now thank you okay was it just me who dropped out or did the whole uh yeah no it was you you froze and then you dropped out so that’s right sorry about that that’s okay um so let’s let’s carry on there um so

excuse me the role of any sort of therapy in my opinion should be particularly as it relates to meniere’s should be about a couple of main things one uh improving quality of life and and managing symptoms when it comes to though it comes to an episode of or an attack of meniere’s most people would feel pretty comfortable in staying at home and not venturing too far so often there’s not much that say someone like myself could do but certainly your first line round of medication could certainly assist but in between sessions we really want to focus on improving your stability improve your mobility reduce anxiety and fear and try to uh encourage you through support and through exercise your return back to normal activities so our focus is really aimed at trying to reduce the frequency of some of these episodes but when they do maybe have a few little uh what we call neura hacks or or other means in which we can reduce the severity but often it’s a case of medication but in between these episodes give you the confidence and give you the tools to be able to um get you back to participating in normal activity as quick as possible

so what can influence these central pathways that i mentioned what is it that we can do to improve your ability to have more adaptation and be more resilient and and this is not an exhaustive list but at least that i go through uh with my patients at one stage or another and it’s um and it’s listed here so we often talked about metabolic which is a broad term that looks at dietary and how your systems or your body work from including blood sugar level to thyroid to anemias to autoimmune conditions to to many things that relate to you know the systems within uh we look at medication and you know whilst i’m not in a position to necessarily uh to uh recommend advise or prescribe medication but even the combination of different medication or what we call polypharmacy is one that needs to be often discussed with patients um autonomic function the the area of the brain that relates to autonomic control of your body parts like breathing blood pressure heart rate gut function stress response are very important things and we’re going to go through each of these in more detail in subsequent slides the sensory interaction between proprioception vision and vestibular function and how the brain processes processes this information are all topics that really should be discussed with your primary practitioner in trying to get those central pathways or central systems uh functioning higher a function better wherever possible i try to include some research just to i guess substantiate what i’m saying so you’re not looking at this as going off colors made this up um he’s only cherry-picking information that relates to to what he does i try to be broad and and certainly many times i’ll be first to highlight where what’s not my area of expertise expertise and one that we should be looking at others but where possible i try to include some some papers that give a broad outline of where we are excuse me

um this is a fairly recent paper actually 2014 that looks at um prevalence and associated factors that go with meniere’s and and this paper really highlights the things that i’ve seen practice and it says this um near disease is commonly found in participants who are of older age have a high bmi or body mass index but they also have at least one disease from each of the groups that relate to allergies immunity dysfunction and autoimmune as well as poor mental health now what’s important and as i say that i’m probably hopefully some it resonates with some and may i unfortunately upset some others a comorbidity or an associated factor is by no means indicative that it’s it causes or there’s a causative link between one and the other but what they’re saying is when they look at a big database of people in this case 1376 patients with meniere’s and then they did a list of what are common traits that these people have and what they found statistically significant is that what is common with those that have meniere’s is these sorts of conditions they suffer allergies they suffer autoimmune conditions they suffer autonomic dysregulation and we’ll go through what that means or a combination of these things including poor mental health so if there’s an association or or a relationship then look at this in a different light look at it as maybe as an opportunity to have these areas evaluated by someone qualified maybe consider adding some treatments a lifestyle change modalities or whatever it might be to enhance your current care for millionaires at looking at well if they’re associated with it maybe i should be addressing these things as well and that’s sort of the main purpose of what i wanted to highlight in this slide

and again hopefully you can see this but again you’ll get a copy of my slides some of the physical and psychological triggers that are associated with meniere’s and this is a great paper that looked at a patient’s perspective so it wasn’t a a really rigorous science scientific explanation but it was really based on uh a survey of patients that have been years um what are the things that are known to be triggers or associated with them so some of the physical things we know diets salts certain meals dairy chocolate caffeine alcohol uh physical factors like tightness uh physical exertion blood pressure uh postural factors regarding head position and we’ll talk a little bit about this later when we talk about autonomic environmental is there a time of the day is it in a windy weather time of the year is there visual stimulus like watching tv supermarkets reading looking uh looking at various things travel as a passengers and flights buses are also known to be some triggers crowded noises accredited environments loud loud volumes some psychological factors stress i think is a common one that most people would agree um and some emotional triggers like weddings christmas certain events can trigger things as well and patterns of association and exposure as well so this is a nice little paper that that helps link some of the things that many of you experience to what others experience as well and again i i bring this in there because if they are associated then are you looking at these factors as part of your code management are you seeking assistance or starting to use some of these therapies that can mitigate some of these responses or provoking factors as part of your care

so let’s start with the metabolic and here we’re referring predominantly to uh systemic um or global aspects that relate to predominantly your dietary components so cardiovascular blood pressure cholesterol these are have been known to be associated with people with minerals so again is it worth getting your blood pressure and cholesterol checked and managing that is that helpful in managing uh and yeah there are some studies that would suggest so blood sugar anemia levels alcohol levels of hormone um being a higher bmi most people would be familiar with salt sensitivities to things like gluten dairy msg and tyramines and in some ways have been linked or have been shown in some studies to be associated with being linked with triggers of meniere’s and other vestibular conditions and these things here are maybe things that you can you can uh check yourself and investigate yourself i would say as a as a primary primary care practitioner i would encourage you to seek advice from those that are more uh trained in this area whether it be your gp whether it be your allied practitioner whether it be a naturopath or otherwise but i think there’s good merit in being able to work with someone who can identify some of these triggers or provoking factors

when it comes to autoimmune inflammation there are many papers that talk about meniere’s disease as an autoimmune condition and there’s some good substantiative evidence to say that that is the case now like most things it’s never a one-size-fits-all for some it might be another another cause but for for a good number of people autoimmune conditions seem to be associated with it and they can include thyroid diseases like hashimoto’s psoriatic arthritis autoimmune arthritis like rheumatoid ankylosing spondylitis and sle which i think some of you would be familiar with it has been linked to a number of viruses from herpes to the chicken pox to cytomegalovirus and covert as a as a practitioner that sees many dizziness patients over the last couple of years i can tell you we’ve seen many many patients that have presented whether it be through through the through the vaccine or through exposure to the to the virus itself um there’s a lot of papers that are now supporting um covid virus as a trigger for autoimmune conditions and its effect on vestibular disorders

when it comes to medication um we’re we’re looking at here um what drugs affect our central processing so i’m not necessarily talking about the drugs that you’ll be familiar with that relates to managing uh menus but i’m looking at drugs that are that can greatly affect your central nervous system and they include um blood blood pressure medication um muscle relaxants sleeping pills diuretics in some instances cholesterol or lowering tablets anti-inflammatory you think hold on if cholesterol and inflammation can contribute to to meniere’s or provoking veneers but at the same time cholesterol and drugs and anti-inflammatory medication can also be a trigger this is where i would suggest you know work with maybe an integrated medical practitioner or a naturopath or someone skilled at looking at maybe non-pharmaceutical means of regulating your cholesterol and regulating your autoimmune inflammatory condition antidepressants also can be can be involved and when we start talking about mixing drugs you know and in most instances for many people um certainly are we taking a single drug it’s normally one drug and another drug to combat something else and then another drug to combat the symptoms of well side effects of those two drugs and when we get this what we call polypharmacy and when you’re taking more than three drugs at one time your risk of falls and your risk of affecting that central nervous system is exponential so this is where i probably would suggest working with your neurologist or your gp and say look i’m concerned about the combination of drugs that i’m taking can we evaluate them can we can we consider them particularly in light of my instability and my dizziness and my meniere so it’s a discussion that i would encourage you to have with your primary care practitioner in particular your gdp

when it comes to neuropsychological this is a big area and again i just want to make the point clear here i’m not necessarily stating that

a psychological condition causes meniere’s or a meniere’s can cause a psychological condition although we do see a strong relationship between them again i’m sure many of you would agree there but understand that if there’s an issue here that relates to mood and depression and and our emotions then it’s one that i would strongly encourage you to consult with with a qualified um psychologist or a counselor that has experience with um working with people with chronic and persistent dizziness now it’s only a small subset of people and i do have people that we work with that can can assist them certainly reach out to me if you need a list of those names um but at the same time working with the with a primary care practitioner that can do rehabilitation they should also be endeavoring to manage some of the mold symptoms that relate to fear anxiety and depression and not by any stretch of the imagination do i suggest that i would step in in place of a counsellor or a psychologist but working with someone giving them the confidence and giving them the understanding of what they uh what they can do and the targets and and all the things that go around a supportive nature therapy you’d be surprised at the sort of benefits that we see with patients that relates to their anxiety and panic and fear and their hyper vigilance and their depression so it can be a side side effect or or a benefit of neuro rehabilitation but in some instances you do need to have that external person uh involved so so as i said said here an association a link doesn’t necessarily mean causative and i just want to make that point because too often we see people that present to our office and they’re being ignored by by their primary care practitioner whether it be the neurologist specialist in t or otherwise and because the condition although they’re not aware of what it is or or how to manage it they’re often just given so many antidepressants or any anxiety medication that they’re asked to well that will fix it um it is a real condition what you’re suffering we are we should be acknowledging that and we should be supporting you in many ways particularly in the neuropsychological field

i’ll read this this is from from this paper and it talks about the influence of psychological factors in meniere’s disease and it says here a vicious circle of interaction seems to exist between the somatic organic symptoms which is basically the dizziness the vertigo the instability that’s the the somatic or what you feel experiences of meniere’s and resultant psychological stress the frightening attacks of vertigo seem likely to produce an increased level anxiety thereby worsening the emotional state and the resultant anxiety provokes various symptoms probably through disorders of the autonomic nervous system accompanied by the increased less levels of stress related hormones and this is what i want to talk about i want to work on i’ll help provoke a discussion and thoughts amongst yourselves about how you can get that the brain to work better to manage what’s going on in the inner ear

so when it comes to neuropsychological assessments um there are many levels um and i’ll talk about the things that i do in our office um and again my job is not necessarily to uh to replicate a psychologist but sometimes to show as a screen to identify where some obstacles might be but also as a yardstick that as time goes by we can see objective measures of change we in our office we use what we call a qeg or quantitative electroencephalogram where patients would wear this funky looking shower cap with electrodes that are attached to the scalp and it measures electrical activity and we get these these pictures that denote areas of hyper and hypo function and with that we can we can see the areas that probably need some support or areas that need a bit more nurturing or areas that need more stimulation and we can gather that from this qeg and from that we can do neurofeedback therapy that can guide um the the patient through through recovery other forms of therapy can be questionnaires like um anxiety questionnaires stress questionnaires dizziness questionnaires tinnitus questionnaires all these questionnaires which some of you may have been exposed to give us a snapshot of where some of the mental health issues or states may be

some of the some of the treatment approaches should always encourage uh what we will refer to as a team approach where we will look at a psych counselor or someone with experience in this area and and they will generally do a full evaluation that may do cognitive behavior therapy um in our office we do a lot of empowerment strategies and therapies we do some mindfulness practices we really try to encourage the patient to take ownership and empower themselves on what they’re experiencing learn strategies or hacks that they can adopt when things aren’t working as good and try to just give them the tools that they can work through this themselves where i was here to support them but trying to get a patient to learn strategies to to manage this independently is one that we we certainly encourage in our office

other strategies can be by feedback therapies we do heart rate variability which is a a very sensitive way to measure the body’s ability to regulate stress and we measure the heart rate as an outcome measure for that stress response and that stress response might be an exposure to something it might be a positional so from a laying to a standing position it might be deep breath there might be a certain position so we look at how the brain responds to stresses and we have people come to us saying that they experience symptoms in certain positions so sometimes we may do a modified exposure to it try to identify trying to get some concept of awareness and then put some context around stabilizing around that that exposure so we can neglect or negate people’s experiences that they often have and there’s a there’s some good little take-home um or home-based therapies you can look at what they call heart math there’s some little training tools that are relatively inexpensive that you could use at home to train the brain to be more resilient to stresses

so i mentioned before about our autonomic system and some of you you may be familiar with it it’s really the uh it’s that autonomic or automatic system in our body that we don’t have to think about so as i chew food my my my mouth produces saliva my gut produces enzymes to digest food as the food goes down my mouth it goes into my tummy my stomach starts to digest the food and as it passes through my abdominal cavity you have this peristalsis or constriction of different parts of the gut and that happens all automatically you have to think about that and that’s just one example so um so it controls our skin our sweat receptors our digestion our breathing our gut function our stress response these are all a product of our autonomic system so when we have dysfunction in that area we can get lightheaded we can get bowel or bladder dysfunction we can get sexual dysfunction we get sweating skin and nail changes and we can get an intolerance to position some of these do need to be evaluated by a cardiologist but more often than not it’s a brain or a central nervous system problem and it’s the brain’s in inability or inappropriate response to a stress that we’re seeing so when you touch someone on their shoulder ordinarily that should be a fairly benign touch and it’s like you turn to the person go hi how are you but if someone’s hyper vigilant and very startled easily as you touch their shoulder you know they get that startle response the pupils dilate the skin blotches they start sweating the gut you know goes into a knot and you know they can’t think about what they did five minutes ago well that’s an inappropriate autonomic response and that’s what we refer to as a dis autonomia or poor dysphon autonomic dysfunction and that’s a really really important thing particularly when it comes to people with meniere’s and something that we we go over and over and it’s one that is often neglected because it’s not an easy thing to assess it’s not an easy thing to manage but it is one that really needs to be considered

and the ways in which we can assess that we have these tilt tables which place position in different positions we’re measuring their heart rate their oxygen saturation their blood pressure their breathing rate and we’re assessing it in different positions and we’re evaluating does gravity affect their stress response and again we can use various techniques that we have in our office but you can use heart math at home using this visual interface an eclipse to measure your heart rate variability and you use breathing mindfulness practice to help calm and ref uh and sedate the body and it’s a great great tool to adjount to to what we do and what you could do

so this is a recent paper that looked at the prevalence of sympathetic or autonomic dysfunction in patients with veneers so people with um with cold sensitivities or cold extremities because they have poor blood supply in their hand uh happens in 97 percent of patients people with shoulder and neck stiffness happening 98 of people with meniere’s um shim lanes um we have ibs which is irritable bowel syndrome tension headaches you know 69 of people are sweating in their hands myograins ear symptoms palpitations gastric disorders stress stress induced skin blotching

asthma ulcerative colitis which is a severe gut inflammatory disorder and chemical sensitivities which unfortunately happens fairly rarely but you can see a lot of these are well over 50 so many people that have veneers have this autonomic dysregulation and many of these all of these symptoms are signs and symptoms of that dysregulation

so how do we treat it what are ways in which we can use to regulate our autonomic system and this is um we spend a lot of time in our office and one that you should be equipping yourself with some home tools um you can use binaural sound so this is an app that you can download unfortunately it’s only on apple um that you can play and it and it has these frequencies of sounds that help calm and relax the body certain frequencies like alpha and beta waves that help relax the brain and we measure that with our qeg you can use these little bio feedback devices called mentech which measures your uh brainwave activity and then through sounds helps regulate its function you can use um smells you know olfaction or smells are a great way to again calm and relax the body we almost always recommend our patients use blue light filters um so either either on their device uh or on the computer or wear glasses that filter blue light smell lights and sounds are three very very powerful senses that our brain uses and we can help calm that brain down by using the right frequencies of lights frequencies of sound and and smells to help regulate it again i’m sure many of you have used these and have found benefits i’m not sure the reasons why because really it helps filter and and control some of these hyper vigilant actions that our brain can go through

other forms of treatment a little bit more technical we can use vibration we have uh vibratory tools that we can apply on our neck we have the vagus nerve some of you may be familiar or heard of the vagus nerve the vagus nerve is the opposite of our fight and flight system the vagus nerve puts our body in our wrist and digest state it’s the one that we really should be stimulating more and any of the things that i showed you in the previous slides can help stimulate that vagus nerve but some more direct therapies can be vibration in particular on your carotid we can use stimulators on your ear little nerve stimulators to stimulate the vagus nerve and in our office we use certain laser lights which can help stimulate the vagus nerve as a as it runs or courses along the carotid um the carotid artery as well as stimulating your gut whether vagus nerve or cell please so there’s different ways in which we can be direct or indirect therapies for stimulating your your rest and digest other things worth considering is your proprioceptive system your your neck your shoulders your jaw conditions like chronic pain migraines insomnia if you’ve suffered from a concussion or whiplash these are all conditions that are known to

alter or for lack of a better word scramble that that brain so what it takes in the information that it takes in is misrepresented and so you can get things like chronic pain um insomnia migraines are a product of that brain stem or brain not working as well as it should so these forms these areas sorry these conditions if you also suffered from them should also be managed because it will have a beneficial impact on your meniere’s most of us have have been exposed to vestibular therapy one way or another look the jury’s still out there are some studies that show that it’s a benefit there are other studies that show that it’s generally not particularly helpful it’s a personal thing i’ve had people swear by it and say that it’s it’s saved them um and others say that it hasn’t in my instance i think the benefit from the therapy comes from the therapists i think if you’ve got a strong relationship with your therapist and you’re working with them and they’re supporting you and guiding you to me that’s where the benefit is more than the exercise in itself now i say that as someone who’s done a phd in vegetable rehab but this is a great paper that was only recently published that looked at a systematic review which is the highest review of research and it looks at all the papers out there and it says it works for some doesn’t work for for some others it may benefit you may not benefit so it’s worth a shot that probably don’t raise your hopes up but that is if you go through the papers they’re really only looking at very standardized rehabilitation it’s not what i would define as a as a neuro vestibular rehab one that looks at the brain in conjunction with the ear these standard therapies only are based on the inner ear and suddenly look at much else

visual processing you know some people when they look at these at these pictures they get um you know their their heart raises a little bit they start getting a little dizzy they’ll turn away from the screen when we have these visual processing issues these relate to how the brain is taking in visual input and we see this quite commonly with meniere’s as well

there are there are tests that we can do i won’t spend much time in this so i would press for time called the subjective visual vertical i encourage you to look at it it’s again when there’s a skew of information from the inner ear the brain doesn’t compensate and so the perception of where vertical line is gets gets skewed and so we may walk around with our heads tilted or at least our perception of their world being not vertical becomes apparent and there’s this test here the bucket tests using a specific app that can help measure subjective visual vertical

um again i’ll pass through this pretty quick but we can measure eye movements through different tests some of you have used these goggles that help record eye movements we can do these we can do these tests that measure and record how you read and we can get this picture of how accurate you are in reading whether you jump words or whether you read word by word

this is a test that most of you have seen when you use these goggles you might do this optic kinetic test and you’re probably seeing your eyes look

amplified with this sort of picture

there are treatments that you can perform regarding eye movement therapy and again i know we’re pressed for time i won’t spend much time in this but there are there are therapies that you can do that involve following a target with a stationary or busy environment and we would grade this along the the scale from being quite easy to more challenging for some people following a moving object like a football when the background is moving like it is here could be quite a quite a difficult challenge and we would work with patients and ensure that they have the capacity to do this

virtual reality is another emerging area that has been shown to be quite helpful in placing people in a in a provoking environment i know that may scare someone to say well i don’t like a shopping center or i don’t like an elevator i don’t like a busy environment so i’m not going to spend any time there it’s not an approach that we would adopt and not one that i would encourage patients i would certainly hold their hands and in a very supported environment gradually do an exposure to these things to a way where they could conceptualize around it they had strategies around it and they felt comfortable around that environment again we want people to live a healthy fulfilling life and doing activities that they enjoy and unfortunately as time goes by exposure to these environments i’ve been social within with their friends it becomes compromised over the time we really don’t want to see that um so training one’s neck and proprioception is really important particularly if you’ve had things like arthritis uh whiplash injuries and migraines training how your neck and spine functions whether it be through passive or active therapies is one again that i would encourage you to work with you can work on people’s jaws you can work on people’s balance on their spine and just on jaw i know the crew is going to talk about this a bit later but my next talk is all about how the jaw can is an area that can be a source of irritation for millionaires and chronic dizziness but also it could be an opportunity to help as well um some of the more emerging techniques at the moment um particularly as it relates to tinnitus not necessarily veneers as a condition but controlling the news a sort of controlling tinnitus transcranial direct current is one that’s been very promising in the last 10 years in ways in which we can stimulate or dampen parts of the brain that relate to auditory processing in particular tinnitus and and it’s been shown repeatedly that this form of therapy can help reduce tinnitus perception and experience excuse me um other forms of what we call neuromodulation is where we can use um photo biomodulation another big words all it means is that we can use these funky looking lasers on different parts of the head as it relates to inner ear function or as it relates to tinnitus so again more recent data over the last 10 years has shown some promise to say that the use of these cold lasers or transcranial lasers can be used to help inner ear function and areas of the brain that relate to either anxiety or tinnitus direct

so yeah this was a um a preface that this this particular study which is uh fairly recent um was in rats so it hasn’t been shown in humans yet but i just wanted to show that because this is incredible laser treatment which is these cold laser therapy uh minimize the damage from the inner ear so these these rats were um had dental mycin injected into the inner ear which as you know kills the and destroys the hair cells in the inner ear what the laser showed it actually um i’ll read it here so it re uh histological study so when they did a sample of the inner ear reflected the functional results shown an increase in hair cell density and and basically it started to repair the function and the anatomy of the hair cells that were previously destroyed now again i preface to say this isn’t a rat this is not something that i would necessarily say this can happen in human but it’s an exciting area that hopefully research will show that to be the case um so look i want to conclude on that i know i’ve covered a lot but i think i just wanted to highlight a few things to you a healthy brain a brain that is more resilient more adaptable is one that’s going to treat you better with with respect to your menus and it’s one that you should be working with a team of people in whatever capacity whether it be mental health whether it be physical whether it be nutrition or biomedical whether it be autoimmune whether it be a combination of all those in ensuring that your brain is as robust as possible in as and can take whatever the meniere’s peripheral issue can throw at it and it has the capacity to be to not affect you as much as what it probably is so i just want to sort of impart that and it’s really the approach that we take in our clinic at brain hub and it’s one that um we’ve had some good success over the years um and and one that we’re continually learning to to enhance and you know we’re bringing on new technology and and think and it’s also things that i teach other practitioners so hopefully uh practitioners that you may see whether they’re scattered throughout australia or or out throughout the world um you know hopefully there are practitioners that have maybe taken a course of mine over the years and um it can maybe impart some of that um information to improving your care so with that said i just you know if you want to reach out to me i’m contacted by different different means and i love to answer any questions i know um the the crew tonight are gonna are taking some questions from from you and from um those that watch the uh they’re recording later and and i’m gonna be working with anne at a later stage and maybe answering some of those questions in different means so um i’ll just finish for the last slide which is one that i i’d love to um to show um love your brain you only have one brain love it because it will definitely treat you better with this and many other conditions that you may or may not have so with that said i’ll uh i’ll pass it back on to the host

thank you thanks carlo yeah really great presentation so much beautiful yeah really i think we need to watch it a couple of times to absorb it all because it’s so much you’ve shared so much with us and it’s some very useful information i’m interested in the laser actually the laser with the uh to help with the hair hair um

i did the cursory checker i didn’t i didn’t look too deep but i couldn’t find anything on the surface that was showing human-based studies that can show regeneration because that’s the game changer because um you know it’s you know we’re all taught that you know gentamicin uh both can be a cause of but also be part of the therapeutic aspect for some and and when you when you damage those hair cells you know it’s taught that that’s it it’s uh not much you can do about it and you just live with it um but it may be that uh for early stages of meniere’s and other conditions and uh if it’s due to toxic conditions or otherwise um it may be helpful for that recovery but jury’s still out on that one um and just one one more thing it’s not a question just um virtual reality where you’ve got the the whole uh head piece on your eyes i mean that must be pretty weird for us people with many years i mean can we lose our balance seriously yeah look we we often start seated so we we have a good grounding we know where we’re at so it’s all graded and that’s the that’s the key to it it’s not you we don’t fully immerse you and go well there you go all the best it’s hold your hand through the process the good thing about the software that we have the virtual reality one which is a practitioner product is that we can change what you see and your exposure so for instance if you’re walking through a shopping centre we might change the speed of it so it’s really slow we might only put a few items on the on the shopping aisles we won’t have anyone passing past you and you’re you know you slowly tiptoeing around and going account i don’t feel too bad about this i’m okay with this and as you get better at it we start making it faster we start putting more things on the shelves we start having people come at you with trolleys and so your exposure increases but it’s done in a very graded progressive way that you’re you’re supported and i can’t stress that enough and that’s why i think what we do works is because we acknowledge where someone is at and we we we hold their hand through that process and there’s always dips and there’s peaks and troughs we get that and we set that expectation but it’s really a matter of just working through it and just you know celebrating those little wins and when we do it’s like but you might come to us saying i just want to go i want to fly a plane or i want to get in a car or i want to go in a lift because my son you know i want to get to the top of the building because i want to see the views of sydney and that’s been one of my goals well we work with patients to try to achieve each of those goals but that comes from an interaction and you know goal sharing and we you know we have health coaches in our office that that help work with patients and setting those goals and overcoming some of those barriers as well so there’s different elements that work and but you know i think i guess working with the right pit crew is really important and you know and i’m not saying that we have all the answers but you know try to look at those different options um and if someone looks at it with the you know with only a one tool approach

in my opinion it’s probably not going to help a great deal it may help the peripheral aspect but it’s not going to help that central component that i mentioned okay thanks carla okay i think we might we should call it a night now okay and yeah thank you really appreciate your time coming thank you really we do appreciate it