Dr. João Filipe Simões

Otorhinolaryngologist

Vertigo consultation.
A journey to the ear and the vestibular system

HPA Magazine 22 // 2024

He recently moved to the Algarve to practice his specialty as an Otorhinolaryngologist at the HPA Saúde Group, but also with the purpose of developing one of his areas of choice and specialization: vertigo.

Hello Dr. João Simões, it's a pleasure to have you with us today. How has your work experience in the Algarve been so far?
Hello, thank you for inviting me to this interview. My experience in the Algarve has been very positive. I am very excited to have the opportunity to continue practicing my activity as an Otorhinolaryngologist in this region and, especially, to be able to continue my work in the field of peripheral vestibular disorders, that is, within the clinical conditions of vertigo, dizziness, imbalance that can be caused by ear problems.
I have been working in this area for several years, to which I dedicated myself especially in recent years in Belgium, the country where I worked from 2019 to 2024, and also in the work carried out for my Doctorate at the Faculty of Medicine of Coimbra.

We're glad to hear that. Can you tell us a little more about these disorders?
Two of the most common cases of vertigo that are usually found in consultations and emergency rooms are benign paroxysmal positional vertigo (BPPV, commonly known as crystals in the inner ear) and vestibular neuronitis. BPPV is caused by the displacement of otoliths in the inner ear and is characterized by brief episodes of intense dizziness, triggered by changes in head position, such as turning over in bed or getting up quickly, hanging out clothes, picking up an object from the floor. Vestibular neuronitis is an acute inflammation of the vestibular nerve, which can cause intense vertigo, nausea, and vomiting for a few days. Then we have other more complex situations, which require additional study and more in-depth monitoring, such as Ménière's disease (classically, patients present deafness, vertigo, and tinnitus) and even other conditions that fall within the domain of other specialties (and which require articulation with them) such as vestibular migraine, for example. It should also be noted that there are other less common but equally disabling situations, such as post-traumatic inner ear dysfunction and vascular injuries, such as inner ear haemorrhage.

Is it possible to prevent these diseases? What can be done to help these people?
It's an excellent question. Except for very specific situations such as a fall or a virus infection, which can favour the occurrence of BPPV or inflammation of the inner ear, respectively, there are no strong arguments regarding other possible causes. This means that any of us can have one or more of these disorders throughout our lives.

One or more? In the same person?
Yes, it is actually possible and it is not uncommon. We may have a patient who had neuronitis and then BPPV. Or a patient who has Ménière's disease or blood flow disorders and who, at a certain point, presents with BPPV. This is why a specialized assessment and a complete differential diagnosis are essential, which will require some complementary tests and even, sometimes, collaboration with other medical specialties. Fortunately, after these steps, we can often help and rehabilitate people.

Dr. João tell us about the importance of rehabilitation in treating patients with vertigo.
Certainly. Vestibular rehabilitation, also known as vestibular re-education, is a fundamental component in the treatment of patients with vertigo and balance disorders. It is a multidisciplinary approach with articulation of the ENT specialty with Physiatry and Physiotherapists. The goal is to rehabilitate the function of our inner ear and balance system and improve our spatial orientation of the body. This includes a wide variety of exercises, from the simplest to the most complex and with very specific technology, which help to improve the patient's ability to deal with symptoms and compensate for the absence of a certain function, which must be detected in exams beforehand. performed. Thus, we help the patient to understand what they have, to recognize the symptoms and to know and master the techniques that help them to have a significant improvement in their quality of life. In other cases, fortunately, we can recover more quickly (most of the time, but not always) and effectively after a correct diagnosis, as is the case with BPPV, in which we perform manoeuvres to “replace the inner ear crystals in their usual location”, explaining in simple terms.

And what approach is usually adopted in the vestibular rehabilitation of patients?
The approach to vestibular rehabilitation varies according to the specific needs of each patient. After a detailed assessment of the patient's clinical condition and symptoms, a personalized rehabilitation plan can be developed that may include head and body movement exercises, visual stabilization techniques, at -home or in a clinical setting in physiotherapy sessions, with specific rehabilitation instruments, among others.
The goal is to help the patient readapt to balance and compromised vestibular function, thus reducing vertigo symptoms and improving their quality of life.

I understood. Vestibular rehabilitation appears to play a crucial role in the treatment of vertigo. Can you tell us a little more about your experience abroad and which entrance exams you are used to taking?
Certainly. In Belgium, I had the opportunity to consolidate and continue developing the skills acquired during my Otorhinolaryngology internship at the Centro Hospitalar e Universitário de Coimbra. It was an excellent opportunity because I continued to have access to a complete and modern complementary study for these patients, with different vestibular study exams, such as videonystagmography, video head impulse test, vestibular evoked potentials, and computerized dynamic posturography, in a very effective organizational system. This allowed us to analyse each patient in detail, work closely with physiotherapists specializing in vestibular rehabilitation, and observe the patients' improvement. It is an excellent project to continue with this aspect at the HPA Group, where this diagnostic exploration can be carried out, namely with videonystagmography at Alvor Hospital.

That's great to hear. Lastly, what advice would you give to someone who suffers from vertigo and is looking for help?
My advice would be to seek specialized medical help. It is important not to forget that a vertigo/dizziness/imbalance attack may or may not be caused by an ear problem. They may also be urgent neurological situations. Differential diagnosis with appropriate complementary exams is always crucial. An accurate diagnosis is essential for effective treatment and helps the person to regain balance and quality of life and, in many cases, to maintain this functionality, as in the case of chronic dysfunctions. Don't hesitate to seek help.