Caloric Irrigation as a Treatment?

limbIn my new position as Director of the Balance Disorders Programs at Wake Forest University Baptist Hospital, I am seeing a whole range of patients that were not part of my private practice. I have been on the job just 6 months (the first two months were dedicated to building the clinic). During that short 4 months time, I have probably seen more complicated, atypical patients than I would see in four years of private practice. The challenge has been both exhilarating and humbling.

 

Some of the most challenging have been teenage girls, with a prior history of migraine, suffering head trauma and concussion, with prolonged vague disorientation and disequilibrium. Throw in some anxiety and motion intolerance affecting the quality and completeness of our exam, and you have got yourself a diagnostic enigma. I decided I had better start learning more about neuro-science and brain function, which leads me to today’s topic. I ended my previous blog with two questions. What else does the brain do with the information received from the vestibular nuclei? Is there evidence of a reciprocal relationship with the neck, trunk, limbs and cerebellum?

It seems that caloric irrigation has been used not just as a test of labyrinthine responsiveness, but also as a treatment for “post-lesional disorders, mania, depression and chronic pain states.”

More specifically, there are published reports in the Neuro-Science literature where cold water caloric irrigation was used effectively (if only temporarily) to treat phantom pain from a missing limb, and successfully relieved the symptoms of a rare psychiatric disorder, apotemnophelia, in which a patient believes that a limb is not their own and seeks amputation of that normal limb.

In one case, a patient that had endured persistent phantom pain from an amputated arm for 11 years experienced immediate relief after caloric irrigation, with the pain returning after 5 to 10 minutes. These instances are believed to be the result of “ an overlap between tactile and vestibular projections in the human brain.”

For a more in depth and amusing read on this subject, read Martha Stortz’ article Pouring Cold Water into Your Left Ear Is a Temporary Cure for Insanity

Photo courtesy of Newbridgespine.com

 

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.