Single Sided Hearing Loss

If anyone has questions about VRT, I may be able to answer them...even though I'm not a VRT specialist. I've spent lots of effort and time to learn as much as possible about the problems of hearing and balance presented by Meniere's. FWIW, I've had single-sided hearing for well over 30 years and never even knew back then that it could be helped...and lived an active life in spite of it. As time went on, my "good" ear lost hearing due to age-related deafness, so I began to wear an aid in that ear. Other than never knowing where a sound is coming from, I don't seem to have any problems related to SSHL.

I'm pretty sure that Mayo has a vestibular clinic and/or specialists. I know that I saw Mayo on a list of VRT places. I'm fortunate in that Portland, OR is a center for vestibular treatment/diagnosis. When he was alive, Dr. F. Owen Black was supposedly the best diagnostician in the country, and he built the vestibular center and all its "fun" machines. He worked with NASA, testing astronauts before and after being in space, esp. John Glenn, who was the oldest astronaut at the time, much older than most. Dr. Black wanted to learn how being in a weightless situation for an extended time affected balance. There are balance specialty clinics in some surprising places, like Fort Wayne, IN. The House Clinic in LA in famous. Portland not only has the vestibular clinic (Legacy Good Samaritan) but also is the home of the international assn. for vestibs: VEDA (Vestibular Disorders Assn.). There was also a balance center in Texas decades ago...

Please understand that VRT is something you must do every day, for the rest of your life...but it's easy to make it just part of daily living once you learn to pay attention to what your feet have to say. I practice walking with my eyes closed on the quarter-mile walk along our one-lane gravel road to retrieve the mail every day, for example. It takes no longer to do that than it does to just walk down there, but is a big part of my VRT. Another thing to do is to get dressed/undressed standing without touching anything (stand beside a counter or dresser in case you begin to wobble). Putting on socks standing without touching anything is a special test--panty hose a REAL test (that I often fail). A simple thing to make is a step 6-8" high (like two 2x4s with a chunk of particle board on top); Eyes open, step down and back up 5X, then repeat with eyes closed, then do the same with your left foot. At first, you need to be next to something in case you begin to lose balance. You also may be surprised to find that you're heading off in a surprising direction, esp. if you have one-sided loss. You can also put a chunk of 2" foam on the floor and practice standing on it, eyes closed. All of those exercises teach you to "listen" to your feet--i.e., learn to use proprioception. You should begin to see some improvement in a couple of weeks, real improvement at the end of a month--IF you do something every day.

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I ain't no doc or expert, but it doesn't sound as though you're learning to use your third balance system (proprioception), which is what makes all the difference. Ever since the forest fire here, I've occasionally gotten so busy providing meals for those who lost everything and are working on clearing their lots so they can move back onto their own land, that I slack off on exercises...and really pay for it! Cooking for dozens of people, sometimes over a hundred, is all new, and it's made more "interesting" because the so-called mobile kitchen has no electricity or water and is seven miles from my house, which has a totally inadequate little kitchen for this kind of serious cooking. At any rate, the exercises you specifically mentioned, like leg lifts, are not really for balance, so I'm concerned that you're not being shown how to do exercises to increase your ability to balance...without using your eyes at all.

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Enough about falling, i.e., imbalance! Everyone should learn to do some vestibular exercises as they age, because our inner ears age just like everything else. Many inner ear diseases offer imbalance as an added "treat." It's well worth it to locate a VRT (vestibular rehab specialist), even if they're not near you, schedule at least a couple of appts., and DO THE WORK! The great thing is that you can practice vestibular exercises while you're walking or moving about; they aren't something where you need to set aside a certain amount of time to do them.

BASICS: You have three balance systems. Your inner ear is your primary balance system, but, when it doesn't work well, you automatically begin to attempt to use your second balance system: VISION. This is really bad, because you'll lose your focal point every time you move or even move your head. Trying to use vision for balance causes falls, nausea, vomiting...a whole list of bad stuff. So, you need to learn to use your third balance system, PROPRIOCEPTION. Simply put, if you're standing on a headland with the wind blowing, proprioception tells you just how much you need to lean into the wind. Prtoprioception is the combination of what all the parts of your body tell you about where you are in space, especially your feet. You may think they're just stupid, but that's not the case. The simplest VRT exercise is simply thinking about what your feet tell you as you walk: check for obstacles ahead of you, then walk without looking at the ground or floor. Dead simple! You'll also be amazed at all the things there are to see! You can do this even while hiking in rough country. The other thing you need to do is to quit walking with your feet further apart (to attempt to balance). There are exercises where you stand, eyes closed and feet close beside each other, and see how long you can avoid wobbling. Then you start to walk short distances in safe places like halls or with someone beside you with your eyes closed. I guarantee you that your balance will improve, plus you'll have better eye/hand coordination in less than a month--and it will get even better after that. I've done some VRT work every single day for nearly 40 years and, in spite of bilateral Meniere's, I've only fallen twice, right after I went bilateral after decades of being unilateral.

Again, you need to find someone experienced with VRT, not just basic PT. When Meniere's became a serious daily problem for me nearly 40 years ago, there were only a handful of VRT specialists in the entire country; it was a new thing back then. So, when I went bilateral a couple of years ago, as soon as I got the monster under control I went to see a VRT specialist at the balance center in Portland, OR two hours away. Because I already knew a fair amount about VRT, I only needed four appts. to get a refresher course. After all, I had learned VRT all those years ago via e-mail!

So, please, everyone whether you think you have a balance problem or not, please try some simple VRT. Hearing and balance are closely tied; the nerves are often intertwined. One of the worst things older folks can do is rely on night lights. Instead, make certain that the path from bed to bath is clear before you retire and, when you need to make that "during the night" visit, do it in the dark until you reach the bath. When you get ready for bed, walk to your bedroom AFTER you've turned out all the lights. VRT really, really works! I'm 78 and still do very difficult instream (wading) data collection for our state fisheries agency. I've now volunteered in the same little river that runs through a very steep canyon on Oregon's north coast for nearly 30 years, and I don't intend to "retire" any time soon. My part of the river involves hiking/wading 3.5 miles upstream and includes crossing the main stem and scrambling up above a waterfall to place and retrieve a temperature monitor every spring and fall. I couldn't do this if I didn't work on VRT all the time. Because I'm all alone in a place that's miles from phone reception, I am excessively careful about wading. You will also learn that challenging your vestibular system by doing something that's a bit difficult will result in improved balance for 3-4 days, a side benefit for me of the ugly job of cleaning gutters.

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@joyces. One of your helpful posts on VRT...I'll send the second most recent one next. You are one busy lady! Thanks for everything you're doing! Nancy

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@barbb Perhaps I did not make not make myself clear enough. When I see the VRT 2/week I do nothing that relates to muscle strength, as I do at home. I am guessing that the reason why I am not doing "balance exercises" at home is because my balance is bad enough to make it unsafe for me to do it without any protection of somebody being available to "catch me" if I should fall or start to fall. When I do the balance exercises with the VRT he is always standing close or walking close to me to catch me as I do them. However, our dialogue about this is helpful because I will seek clarity with the VRT when I see him next about doing balance exercises at home.

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Barb B, in response to your VRT not assigning you balance exercises at home: Personally, I think some PT and VRT folks don't want to overburden anyone with difficult things. However, it's often necessary to do difficult things to improve. You might ask about simply standing on a 2" thick or thicker chunk of foam (like an old camp mat or a chunk bought at a fabric store, even a pillow filling) at home, when there's something solid on both sides of you in case you begin to wobble. Do it first eyes open, then eyes closed. That's a pretty safe exercise to do by yourself. Another is to walk with eyes closed in a hallway with nothing to trip you up (no throw rugs). They may be called "throw" rugs because they can throw you! A good practice is to walk in low light situations, inside at first where you have checked for anything that could trip you, then, after lots of practice, outside...if you live where there's not lots of ambient light. Here, in the spruce woods, the nearest street lights are a very long distance away, and there are no other houses to provide light, so I walk our rough gravel road or even over the very uneven "lawn" (not grass, just whatever is there to be mowed, with frequent gopher mounds). It's crazy that VRT people avoid having you do anything "too dangerous" at home...because your everyday movements are dangerous if your balance isn't good! I know that, after I went to the specialist and got some additional ideas of things to do, I quit nearly falling every time one of the pets suddenly walked behind me in the kitchen. Before working on balance, I had been coming close to falling multiple times every day, but, after working on balance, I'm much more stable and stepping back onto the cat's tail doesn't make me come close to falling. You can walk in the dark or with your eyes closed safely in a hallway...if you're really, really unstable you can lightly touch the wall on one side to orient yourself. Even with that, you're learning to rely on proprioception instead of vision.

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@joyces I really appreciate all your detailed comments. I do plenty of difficult things when I'm with my VRT but that is only 2/week. The foam cushion exercise I do with my VRT but that I could do at home, in only 1 place which is in my kitchen, with a counter top on either side. Walking down the hallway with eyes closed without touching the wall is absolutely not possible at this point. Doing so while touching the wall, I don't know if I would feel safe enough at this time. I will see. You are certainly a reminder of what cats can do to you! LOL. Fortunately, the one cat I have now is pretty good at not challenging me! I do think of my feet a lot, following your long ago suggestion. However, when I do that, it tends to be about the foot in the shoe or boot and also about how the sock feels! (Don't know if that counts towards proprioception!) Your support is precious! Thank you.

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@joyces Hi Joyce, I've been meaning to write you ever since you described in long, wonderful detail all that you went through to master your balance issues. First I should say, I have you to thank for getting myself to VRT. After reading what you had to say, I called my internist and asked her to write me a prescription and then I found a VRT - so I consider myself not really doctor-referred to VRT but self referred - or I could say, "Joyce-referred"! (:-) )! So my note here is a response to that and my own experience with doing VRT, which is notably different from yours. I have been going, on average 2/week for my VRT! I have been religious about doing the exercises my VRT has prescribed which are geared to developing muscles in the hip area (and perhaps more, I'm not sure). So I do clamshells, hydrants, leg lifts for 1/2 hour every day. The kind of exercises you mention I do with my VRT. They are very challenging for me. My head gets tired - and maybe a little dizzy doing them. (I hope that makes some sense to you.) After weeks of seemingly no progress, I asked my VRT about his expectations. Bottom line: (if I understood correctly, he doesn't expect noticeable improvement but rather sees the exercises as preventative of further balance issues! At this point I have had 60 sessions with him and until last week, I was aware of no sign of improvement at all when walking about town (big city). Also, when I asked him about what could be the cause of my very bad balance, in addition to a damaged balance nerve because of benign tumor removal from acoustic nerve, he simply said he couldn't know because there are so many possibilities. As for one day last week when I seemingly, suddenly, had a significantly improved experience, I am wondering whether that was a onetime thing or whether, after so much time has elapsed, there actually is improvement! The winter snow storm has made it difficult to test that out and I had to cancel my VRT app'ts since I cannot risk a fall. I wanted to believe your insistence that exercises will make a difference but until last week, had come to think that progress partially depends on the nature of the cause of the balance problem and thus your optimism could not be valid for all but now, after the one good experience, I'm in a wait and see mode, to see if what I experienced last week was not a fluke!

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Joyces and Barbb..... Thank you for your ongoing discussion of balance issues. I am still looking for a VRT. Most seem to focus on the increased strength as in the exercises you do at home Barb. I think I need to take another look and see if they do the balance exercises in the office. My balance sees to get worse every day and with that the nausea also increases. I don't eat much since food has no appeal and have lost 35 lbs in the last two years. Also have an autoimmune disease, Takahusus Arteritis. Treatment for that caused a NTM lung infection. Antibiotics for the lung infection caused the hearing loss and the balance and dizziness issues. Had to give up the antibiotics, was stable for 3 years but now the lung disease is suddenly getting worse. I have to decide if I want to do antibiotics again. I am completely dea f now so antibiotics can't affect hearing. But they can cause balance to get even worse and loss of color vision. It's a real merry-go-round and I feel like I am losing bits of myself every day. Very depressing.
That was just some background. I do some of the Vestibular Rehab exercises every day but have seen no change yet. I looked online for different exercises but all that came up was referrals to physical therapists. Does anyone know if there is a book that spells out different exercises for vesticular rehab or proprioception? Joyce, you should write one! If anyone has any ideas for me, I'd appreciate it. Thanks....Judy

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