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Home Icon / Articles / Published Academic Articles / Amelioration of Hyperacusis Impacts Vestibular Symptoms & Binocular Vision Dysfunction in TBI patients

Amelioration of Hyperacusis Impacts Vestibular Symptoms & Binocular Vision Dysfunction in TBI patients

INTRODUCTION

Patients with binocular vision dysfunction (BVD) have vestibular symptoms (dizziness, nausea, gait abnormalities) as well as headache/head pressure, neck pain, anxiety and unclear vision. Treatment of BVD with glasses containing micro-prism lenses often reduces these symptoms. One cohort of patients with traumatic brain injury (TBI) did not improve as expected, and all admitted to hyperacusis. This study’s purpose is to demonstrate reduction of residual symptoms with noise cancelling devices.

Methods:

This retrospective study includes 23 patients with TBI presenting for annual vision examination, previously diagnosed with BVD and treated with glasses containing micro-prism lenses for >1 year, who had residual vestibular and BVD symptoms and who admitted to hyperacusis. Baseline data included completion of the modified Khalfa questionnaire, and subjective 0-10 scoring of headache, neck pain, dizziness, unsteadiness walking, nausea, anxiety and light sensitivity. Sound cancelling earbuds or headphones (Bose QC 30 earbuds or QC 25 headphones) were placed upon the patient and subjective symptom scoring was repeated. Then the vision examination was performed with the patient wearing the noise cancelling device. Post-examination, subjective symptom scoring was repeated with both the updated vision prescription and noise cancelling device in place.

Binocular Vision Dysfunction

Humans experience binocular vision, where both eyes work together as a team to see a single image. Binocular vision dysfunction (BVD) occurs when there is a breakdown such that a clear single image is not obtained. Rather, the person experiences diplopia (due to strabismus or tropia) or blurred / shadowed vision (due to heterophoria). Our research indicates that symptoms are most commonly due to very subtle vertical heterophorias (<2 diopters), which are below the sensitivity of the traditional testing. Treatment with a trial fitting process using microprism lenses results in an 80% improvement of subjective symptoms.

Hyperacusis & TBI & BVD

Hyperacusis is a debilitating hearing disorder characterized by an increased sensitivity to certain frequencies and volume ranges of sound resulting in difficulty tolerating everyday sounds. These are physically uncomfortable for the patient, but not for others.

Many of the patients treated in our clinic have BVD induced by a TBI. In this population, a subset was identified that did not respond as well as their cohorts to treatment of their BVD with microprism lenses. They had persistent dizziness, nausea, gait and balance disturbances (slow and unsteady), neck tension and headache/head pressure and anxiety. The one symptom they all had in common was hyperacusis.

Methods:

See Abstract for full details. In summary, patients with TBI previously treated for BVD with microprism lenses who had residual vestibular and BVD symptoms and who admitted to hyperacusis were treated with noise cancelling headphones or earbuds.

Read the full research paper with figures (PDF)

Authors: Debby L. Feinberg, Mark S. Rosner

Posted online:February 1, 2020, Vestibular Disorders Association (VEDA).

Prism vs. Prozac: A Novel Approach to the Amelioration of Anxiety

Poster presentation at: The Anxiety Disorders of America Annual Meeting, Arlington, VA, April 2012

Chronic Headache Amelioration with Prismatic Lens Treatment of Vertical Heterophoria

Poster presentation at: The American Headache Society 54th Annual Scientific Meeting, Los Angeles, CA, June 2012

Dizziness Ameliorated With Prism Treatment of Vertical Heterophoria

Poster presentation at: The American Academy of Otolaryngology – Head and Neck Surgeons Annual Meeting, September 2012

Validation of the Binocular Vision Dysfunction Questionnaire (BVDQ)

Posted in: Otology and Neurotology, January 2020

Authors: Debby L. Feinberg, OD, Mark S. Rosner, MD, Arthur J. Rosner, MD

Visual disorders and Mal de Debarquement Syndrome: a potential comorbidity questionnaire-based study

Published in:Future Science | 2022 | FSO813

Authors: Cherylea J Browne, Paul Fahey, Stella R Sheeba, Margie H Sharpe, Mark Rosner, Debby Feinberg & Viviana Mucci

Identification of Binocular Vision Dysfunction (Vertical Heterophoria) in Traumatic Brain Injury Patients and Effects of Individualized Prismatic Spectacle Lenses in the Treatment of Postconcussive Symptoms: A Retrospective Analysis

Published in:PM&R | Volume 2, 244-253, April 2010

Authors: Jennifer E. Doble, MD, Debby L. Feinberg, OD, Mark S. Rosner, MD, Arthur J. Rosner, MD

Vertical Heterophoria Treatment Ameliorates Headache, Dizziness and Anxiety

Published in: Optometry & Visual Performance | Volume 8 | Issue 1 | 2020, March

Authors: Debby L. Feinberg, Mark S. Rosner, Arthur J. Rosner

Vertical Heterophoria Treatment Ameliorates Headache, Dizziness and Anxiety

Posted presentation at: The American Academy of Optometry Annual meeting, November 10, 2016

Authors: Debby L. Feinberg, Mark S. Rosner, Arthur J. Rosner

Amelioration of Hyperacusis Impacts Vestibular Symptoms & Binocular Vision Dysfunction in TBI patients

Posted online:February 1, 2020, Vestibular Disorders Association (VEDA).

Authors: Debby L. Feinberg, Mark S. Rosner

A Retrospective Analysis of Vertical Heterophoria Treatment and Amelioration of Post-Concussive Disorder Symptoms Utilizing a Multifaceted Assessment Battery

Poster presentation at: The 9th World Congress on Brain Injury, Edinburgh, Scotland March 2012

Identification of Binocular Vision Dysfunction (Vertical Heterophoria) in Traumatic Brain Injury Patients and Effects of Individualized Prismatic Spectacle Lenses in the Treatment of Post-concussive Symptoms: A Retrospective Analysis

Poster presentation at: The Anxiety Disorders of America Annual Meeting, Arlington, VA, April 2012

Treatment of Vertical Heterophoria Ameliorates Persistent Post-Concussive Symptoms: A Retrospective Analysis Utilizing a Multi-Faceted Assessment Battery

Authors: Mark S. Rosner, Debby L. Feinberg, Jennifer E. Doble & Arthur J. Rosner

Published in: The journal Brain Injury, February 2016.

Binocular Vision Correction for the Treatment of Vestibular Symptoms

Authors: Debby L. Feinberg, Mark S. Rosner

Published online: November 2, 2016, Vestibular Disorders Association (VEDA).

Watch these videos of BVD patient experiences:

https://youtu.be/zbkMNPXefpc

Avi's Binocular Vision Dysfunction Story

https://youtu.be/n4qG_8QbArQ

Brandon's Binocular Vision Dysfunction Story

https://youtu.be/WMR8LsiIUA0

Riley's Binocular Vision Dysfunction Story

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Dr. Sandy DiPonio earned her optometry degree from Illinois College of Optometry in 1996. She is a highly skilled and experienced eye care professional dedicated to giving her patients of all ages excellent and compassionate care. She has a wide variety of experience in binocular vision, pediatric and adult eye care, ocular disease and contact lens fitting. She strives to provide each of her patients the best quality of life they can achieve with their vision through knowledge and education of treatment options.

Dr. DiPonio is a member of the American Optometric Society and Michigan Optometric Society.

Dr. Sally Hoey has been practicing optometry since graduating from Michigan College of Optometry in 2001. During her time in optometry school, she developed an interest in binocular vision, culminating in a senior thesis involving binocular vision.

Prior to joining Vision Specialists of Michigan, Dr. Hoey specialized in the diagnosis and treatment of vision-related learning problems as well as other binocular vision disorders. Her other areas of interest include specialty contact lens fittings and treating dry eye. Dr. Hoey strives to provide her patients with clear, comfortable vision while meeting their individual needs at the same time.

Dr. Hoey had the opportunity to provide eye care on an optometric mission trip to Guyana, South America and vision screenings at a local medical clinic. She is a member of the American Optometric Association, Michigan Optometric Association, Metropolitan Detroit Optometric Society and the College of Optometrists in Vision Development.

Dr. Jennifer Place graduated with honors from Michigan College of Optometry in 2001.

Before joining Vision Specialists of Michigan, she specialized in treating pediatric and adult patients with binocular vision disorders and vision-related learning problems, as well as fitting specialty contact lenses and managing various types of ocular disease. She enjoys working with patients with unique visual needs, and she takes great pride in providing all patients with highly customized care.

Dr. Place has volunteered for Opening Eyes, a program that provides eye exams to the athletes of the Michigan Special Olympics, and she participated in an international mission to St. Lucia to provide eye care to those in need. Dr. Place is a member of the Detroit Optometric Society, the Michigan Optometric Association, the American Optometric Association, the College of Vision Development, and the Optometric Extension Program Foundation.

Dr. Mary Jo Ference has been practicing optometry since 1990 upon graduating from Ferris State University- Michigan College of Optometry, and is certified in Low Vision Rehabilitation. She has worked at Sinai-Grace Hospital systems for over 20 years before joining Vision Specialists of Michigan in 2013 to work with binocular vision disorders. Her clinical areas of expertise include visual rehabilitation of pediatric and adult patients who have suffered from brain trauma, injury or disease. She has taught both optometry and ophthalmology residents at Sinai Grace Hospital. Dr. Ference has sat on numerous boards, including Sinai Grace Hospital, Berry Out-Patient Surgical Center, and Seedlings Braille Books for the Blind. She is actively involved in area school districts to provide education, training and access for students, teachers, OT’s and PT’s to eye care service rehabilitation information. Dr. Ference has lectured extensively nationally and internationally.

Dr. Debby Feinberg began practicing Optometry in Oakland County in 1983, upon graduating from Illinois College of Optometry. She joined her father, Dr. Paul C. Feinberg, at Mall Optical Center, which was located in Summit Place Mall.

Since 1995 Dr. Feinberg has been developing the field of NeuroVisual Medicine which is the optometric subspecialty that identifies and treats neurological / medical symptoms that originate directly or indirectly in the visual system.

Dr. Feinberg has been performing pioneering work with Binocular Vision Dysfunction (BVD), a condition where a vision misalignment (frequently subtle) creates difficulties with the two eyes working together to create a single 3-dimensional image, and difficulties with the two eyes following that image as it moves.

The symptoms caused by BVD are not usually associated with problems with the visual system, and include headache, dizziness, anxiety and panic, persistent post-concussive symptoms, gait instability and balance problems, frequent falls, neck pain, motion sickness, nausea, and reading and learning problems.

In 2004. Dr. Feinberg established Vision Specialists of Birmingham, specifically designing the practice to accommodate the needs of the NeuroVisual Medicine patient.

In 2011, the office moved to its current location in Bloomfield Hills and updated its name to Vision Specialists of Michigan.