Kairos moment: Vestibular system
Christoff Truter
Spousal caregiver
When observing my wife’s medical condition retrospectively, I try to identify what my late father used to call Kairos moments. In other words, identifying the tipping points, the moments in time that brought us to where we are now.
One of those moments I identified was when she started complaining about strange symptoms around her eyes. It is often said that the eyes are the windows to the soul, which I always thought was a metaphorical expression.
Ironically, the eyes are often early indicators of underlying neurological conditions, which turned out to be true in her case.
This was not some esoteric narrative that certain doctors later wanted to push. It was mechanical. I am puzzled that none of our doctors explored this moment in time any further, because this inflexion point is an important clue.
Whenever she tried to close her eyes, they would almost automatically pop open to the point where she had to constantly force them shut at night. This led to severe vertigo, followed by nausea, where it felt like the room around her was spinning.
One morning, she woke up completely off balance, almost like someone with a severe middle ear infection. The GP even observed redness around her tympanic membrane. A series of blood tests was done, but everything came back negative. There was no middle ear infection, no influenza, and even the COVID test came back normal.
Let us pause at this moment in time.
We can get very technical here about facial nerves, vestibular nerves and ocular motor nerves. It basically boils down to vestibular system issues that were clearly mechanically triggered.
This is not unprecedented. An article in the Journal of International Advanced Otology (2020) reports that facial nerve activity, such as in hemifacial spasm, can mechanically affect the vestibular system, causing dizziness and imbalance. It shows a connection between facial nerve discharges and vestibular symptoms, highlighting how nerve-induced pressure or stimulation can trigger vertigo.
At this point, one would reasonably expect that the attending doctors would consider vestibular testing such as ENG or VNG, VEMP, or caloric tests, or at least order an MRI that targets the inner ear and surrounding structures using high-resolution sequences. Perhaps even suggest vestibular rehabilitation therapy.
At the very least, it would have made sense to involve an ophthalmologist early on, especially given that she reported symptoms consistent with optic neuritis at the time. Unfortunately, this was only considered more than a year later, by which point it becomes very difficult to image an event that occurred so far in the past. At best, one of the machine learning models suggested there might be subtle atrophy possibly indicative of prior optic neuritis, hardly conclusive evidence.
That did not happen. Instead, this initial Kairos moment was concluded with a five-minute assessment by an overworked neurologist. (We only have 150 neurologists in a country of 62 million people). She was then handed over to a physician who simply vanished, forcing us to seek help in another part of the country (two months later), since very limited help is available in our city.
More about that in a future post.
Along with the balance issues, which at the time rendered her wheelchair bound, she suddenly began suffering from severe hyperacusis and photosensitivity (vestibular migraines). These symptoms are common in vestibular disorders affecting the inner ear and brainstem pathways.
With time and extensive rehabilitation, the balance issues have mostly resolved, although occasional remnants still occur. Unfortunately, vertigo, hyperacusis, and photosensitivity persist up to the time of writing, and certain movements of the fingers, arms, and neck consistently trigger symptoms.
Now, dear reader, do you think it is reasonable to claim that these sensitivities of the ears and eyes are purely functional (attribute it to FND) and unexplainable in nature, even though their origins can clearly be traced back to a mechanical provoked pathology that triggered vestibular system dysfunction?
What happened to ruling out organic physiological causes?
