Dizzy & Vertigo Institute
Sep 26 · 27 min read

The Dizzy & Vertigo team sat down with Dr. Gene Liu, a phenomenal ENT specialist, to settle the score once and for all — when should you see an ENT specialist over an Audiologist for dizziness-related issues? They discuss their overlapping areas of work in the vestibular system, touching on allergy and sinuses to migraines and other conditions that affect dizziness. All that and more in this week’s episode of Deep In Dizziness:

The following is the transcription of this conversation

Dr. Nava:

Hello and welcome to our podcast: Deep in dizziness. My name is Dr. Chelsea Nava and this is my incredible partner, Dr. Brooke Pearce. We specialize in leading vestibular diagnostic testing and therapeutic techniques. I’m pretty excited about today’s show.

Dr. Pearce:

You should be. Today’s topic is going to be all about providing helpful resources and education for dizzy patients. Specifically today we’re going to be chatting through reasons why a patient would see an ear, nose and throat physician for their dizziness and imbalance. We’re going to be discussing common trends of allergy and sinus related issues, migraines and other conditions that can affect the inner ear. So without further ado, we are going to be introducing Dr. Gene Liu.

Dr. Nava:

Dr. Liu is a board-certified otolaryngologist, head and neck surgeon, or also known as an ear, nose and throat doctor located in Los Angeles based out of Cedars-Sinai. This guy is the real deal. He received the physician of the year in 2014 for the Cedars-Sinai medical care foundation. And of course still carries that title today in our hearts.

Dr. Pearce:

It’s cute. I couldn’t have said it better myself. Thank you so much for being here today. So let’s start with the crazy stuff. So you drove down this morning from Los Angeles. So how was the drive?

Dr. Nava:

Drive wasn’t bad. I was telling you earlier, one of my pet peeves is being late to anything. So I left with like an hour cushion just for anything that may come up. So that early in the morning there wasn’t a whole lot of traffic. But you know, everything in LA takes a little over an hour or so.

Dr. Pearce:

Yeah. So you are here. So welcome. We are ready to get started.

Dr. Nava:

All right, so I’m not gonna lie, I was creeping around Instagram per usual and I stumbled upon your biography and I’m intrigued. Okay. It specifically reads and I quote, “booger picker, ear wax remover, entrepreneur, podcast addict, lifelong learner, lover of carbs, a fan of the Oxford comma and subjectively reports that he is not a fan of tequila. We don’t necessarily have to get in that part right now unless you want to elaborate on that. And on the Oxford comma, because I never knew and I thought I’m pretty old at this point.

Dr. Liu:

Alright, well we’ll tackle tequila first. Yeah, I mean I think almost everybody on the planet had some bad experience with tequila at some point in the past. I won’t get into the exact stories with mine, but certainly, tequila and I are not friends at all. And tequila has on many occasions made me very dizzy. So for the Oxford comma, when you’re writing something and there’s a list, let’s say I’m talking about different colors, blue, gray, yellow and white. It’s “Do you put a comma before the and.” So the Oxford commas that comma right before the and, it drives me nuts when it’s not there.

Dr. Nava:

For some reason, I thought it was some sort of journal things part of the Oxford, but that’s good. So in regards to that tequila and dizziness, you know, is that what is that dizziness kind of spark your interest in becoming an ear, nose, and throat? But first, you know, a lot of our listeners most likely don’t know what an ear, nose and throat doctor is. Can you elaborate on what that entails?

Dr. Liu:

All right, so the short answer for our specialty, which is colloquially is ear, nose, and throat. The kind of fancy muckity muck, formal name of the specialty is otolaryngology head, neck surgery, which is a mouthful. If I ever tell people I’m an ENT, half of them think I ride around in an ambulance. Hence the booger picker or ear wax mover. You know, it’s a great intro at cocktail parties. It kind of gives everyone a little pause, but everybody kind of gets that part of it. The short answer is we take care of, take care of everything above the collar bones except for the eyeball and the brain. So in a lot of medical specialties, you have two sides of the same coin. So for example, internal medicine manages most medical problems. General surgery takes care of most of the surgical problems, or neurosurgery and neurology, colorectal surgery and gastroenterology, ENT is one of those specialties where there isn’t a differentiation between the surgical side and the medical side. So we take care of not just patients who need surgery, but also in the initial workup and diagnosis in the office. So we also have a lot more patients that we follow that never need surgery in the office over time.

Dr. Pearce:

So how did you specifically fall into otolaryngology? What was your journey kind of from medicine and then obviously into that specialty?

Dr. Liu:

You know, everybody has a different path to choosing what specialty they end up going into. I think a lot of people go into something that they or their family member had an exposure to growing up. Luckily I didn’t have any relatives or even close friends that had any serious medical issues. For me, it started off purely being a very kind of academic or physiologic, biologic interest. The complexity of, for example, the voice box or the inner ear or the sinuses from an anatomy standpoint, kind of the three dimensionalities standpoint and also just the complexity of what disease States or processes can happen kind of up here just was fascinating and it really kind of drew me in. I feel like even though it seems like a small area of the body, there’s a lot going on there. So there’s always something to keep up with or to learn. Many different parts of the body. So the inner ear is really a complex system that detects not only hearing but also head movements. So the inner ear from a balance standpoint.

Dr. Nava:

So in your words how would you explain to your patients how the ear plays a role in balance?

Dr. Liu:

So balance is one of those funny things where it really involves many different organ systems and their movements of straight lines. When you’re going up and down in an elevator and you feel that kind of start stop or you’re in a car and it’s starting to go forward or coming to a stop those straight line kind of movements are detected by the inner ear. But part of your balance is also your eyesight. So when you’re sitting at the stoplight next to a car and they start moving and you just catch it out of the corner of your peripheral vision, you perhaps in that very instant, your eyeballs are telling you that you’re moving, your ears are telling you that you’re not.

Dr. Liu:

And in that moment, things are just a little off, right? So part of it is does the eyesight and the visual signals match with the inner ears are telling your brain? Certainly it evolves all the neurological processes of how it’s taking in all of the information, integrating it, putting it together. It’s also your sense of touch. So even if you just lightly touch something with your hand on each side, it gives you another bit of information that helps kind of stabilize you. So even if you’re not holding on for dear life, just a light touch to something will give you that extra sense of balance. It’s also muscle tone and strength. It’s, you know, spine alignment. Kind of peripherally too, if you’re dehydrated, you’re run down, you’re tired, you’re stressed, your blood pressure is a little bit low, your blood sugar is a little bit low. Those can all indirectly affect balance as well by perhaps not giving as much blood flow or oxygen to the brain or other end organs. So it’s really this complex interaction between all of these things that ultimately give you a sense of balance of which the ear certainly plays a big part.

Dr. Pearce:

What I think is really interesting is that we tend to get patients in the clinic that have the dizziness but is associated or secondary to their allergies or sinus related issues. Can you explain a little bit of this common trend that you are seeing with your patient population with regard to the allergies and the sinus component?

Dr. Liu:

Yeah. So kind of allergy and sinus issues are somewhat indirectly related, but certainly we’ve all had that experience. When let’s say you’re a little bit stuffed up or you have a little bit of a head cold, where on the one hand everything is a bit foggy, maybe you’ve got some pressure in your head and it just kinda throws everything off a little bit. But also there’s a little tunnel called the Eustachian tube. It’s a little muscular tube that connects the back of the nose up to the little space behind the ear drum that we called the middle ear. And that little space called the middle ear is where we feel the pressure build up when we drive up and down over the hill or go up and down in an airplane or certainly go into the deep end of the pool. So when pressure builds up with those altitude changes, we yawn, we swallow, we wiggle our jaw and those actions helped the Eustachian to open and close.

Dr. Liu:

But that connects back to the back of the nose. And that’s why when you pinch and blow, you can puff up air behind the ear and feel comfortable. So when near that opening in the back of the nose, things are either swollen or drenched in mucus and snot it makes it more difficult to equalize the pressure. And when the middle ear is off it kind of throws off everything else with the ear as well. So beyond making you, let’s say, foggy from an energy level standpoint, perhaps you didn’t sleep as well, you’re a little bit more run down, you feel like you’re not getting as much air, your brain is struggling with all of those. And then on top of that, potentially some pressure regulation issues in the middle ear it can definitely throw off your sense of balance.

Dr. Nava:

So what do you typically do for those patients that come in with that, with those issues?

Dr. Liu:

When it comes to allergies or sinus problems, I mean, there’s a wide range of severity and situations where people can have symptoms. So, you know, on the super mild side, there’s some people where you know, they’re perfectly fine until they go to grandma’s house and there are five cats.

Dr. Nava:

That’s a lot of cats.

Dr. Liu:

Because one cat isn’t enough to cause the problem. And depending on what you’re sensitive to, then you can certainly have very dramatic, very year round problems. So, in the super mild settings we may not do anything. You know, people usually self-medicate. Like let’s take a Claritin, use some Flonase or other type of allergy medication once in a while as needed. There are definitely times where if the problem is frequent enough, severe enough, prolonged enough, that we may even put people on prescription medications. There are times where it’s helpful to know what you might be sensitive to. So, the example of grandma and five cats. It’s usually pretty straight forward.

Dr. Nava:

Put down the cats. (Disclaimer: Dr. Nava was joking. We love cats… and PETA!)

Dr. Liu:

No comment there.

Dr. Pearce:

You’re gonna have PETA all over you.

Dr. Liu:

So if every time you see a cat, you get itchy sneezy stuff. I mean, that’s pretty straight forward. You don’t need a test to tell you that. But there are times where people are sensitive to something that they never realized. So I just had a kid a couple of weeks ago, always stuffed up, always kind of off And for varying reasons, had been substituting almond milk instead of kind of dairy. Turns out, was very dramatically allergic to almonds and never knew it. And that was driving everything. So without a test he never would have realized that we never would’ve figured out. So sometimes we do allergy testing and that can be a scratch or kind of little pokes on skin. It could be blood draws or me different ways to test for allergies and sensitivities, either environmental or dietary. And so in situations where you’re really trying to figure out what you’re sensitive to or how you can manage it, testing can be helpful.

Dr. Liu:

And if it’s really bad and you’re not responding to medications, then some people do get immunotherapy or in the old days, allergy shots. And now there are other ways to do that. The idea is to build up a tolerance to what you’re exposed to. So going back to tequila, right? The first time you ever have a shot of tequila, you’re probably hammered. And the second time you have, you’re hammered. But if you keep doing a shot of tequila every day after a certain duration of time, one shot doesn’t really do anything for you anymore. Right? And so you build up a tolerance to that alcohol. Allergy shots or immunotherapy kind of work the same way. So let’s say you have a certain amount of a pollen pushes you over the edge to where you’re itchy sneezy stuffy, then the idea is to expose you to just a little bit less than that on a regular basis.

Dr. Liu:

And then slowly creep that up higher and higher so that after a while, that same amount of pollen really doesn’t do anything to you anymore. So that’s on the allergy side. Now from a sinus standpoint, allergies certainly can cause sinus problems. Other people will have a lot of sinus issues, sinus infections because of structure or anatomy. So if inside their nose the sinus openings are narrow or if they have polyps, I mean there are other things that can go on and that can be a deeper evaluation. Certainly the allergy is always part of a sinus evaluation. It may involve little cameras in your nose, it may involve cat scans, but it’s really looking at anatomy and structure exposures and sensitivities and partly whether or not there’s any issues with the immune system, otherwise.

Dr. Pearce:

Can you kind of back up a little bit and go back to the Eustachian tube? So explain a little bit more about, you had mentioned Eustachian tube dysfunction. What role that plays in potential dizziness and what you do in those situations?

Dr. Liu:

Right. So the Eustachian tube is a body part. The word dysfunction really doesn’t tell you what’s causing it not to work well. It’s just kind of a generic term to describe that mechanism or that pathway isn’t quite doing what you want it to. So Eustachian tube dysfunction can be caused by sinus and allergy problems like we’ve discussed a, another frequent reason have you Eustachian tube dysfunction is somebody who has a lot of musculoskeletal problems. So it’s a muscular tube that needs to open and close. As an example, if somebody is clenching and grinding a lot on a regular basis, all of the muscles in and around the jaw can be super tight so that when they try to wiggle their jaw or yawn, you don’t get that same release or opening of the Eustachian tube. Some people are certainly born with just Eustachian tubes that are narrow or small or short or oriented in a funny way. And others end up with let’s say scarring from procedures or God forbid if somebody had some sort of sinus tumor and radiation to the area really the treatment for Eustachian tube dysfunction depends on what’s causing it in the first place. So there isn’t like the, aha, you have Eustachian tube dysfunction. Here is the answer. You really have to dive in deeper to figure out what’s causing that dysfunction.

Dr. Nava:

This is a little bit of a side note, but cause I always chew on my left side. This masseter is bigger. Now everybody knows my flaw, which is awesome. So stop looking. Yeah, and this ear is always the last one to release and it’s because of my abnormally large masseter. I’m trying to work on it. She’s like, just chew on the other side. No, that’s not how it works.

Dr. Liu:

Just Botox the daylights out of that.

Dr. Nava:

I tried, it didn’t work out. So in that case I just tell her. Well, why don’t you walk with your left foot first every single time. You can’t just do that. But that had just helped me out. But thank you very much for explaining that to me. I appreciate that.

Dr. Pearce:

Well, what I think is really interesting is that we’ll have patients come in that will report aural fullness. Talk a little bit about the migrainous component you had kind of briefly brought that up. So tell us a little bit about vestibular migraine and what that sensation of aural fullness looks like.

Dr. Liu:

So split it up and talk about that feeling of fullness first because that’s something that can be caused by a lot of different things. So when you’re looking at the ear, you have that little tunnel that everybody looks in when you go to the doctor’s office, right? That’s the external ear or the external auditory canal or ear canal. Anything that blocks the ear canal can give you a sense of fullness. You know, big ball of wax. Oh, you’re stuck in an earplug and forgot about it. A little kid with a bead. But if there’s anything sitting in your ear canal, they can certainly give you that sense of fullness. I mentioned earlier with the eustachian tube. So if you’ve over, or under inflated the middle ear, even just driving over the Hill or the airplane kind of analogy at the moment before you kind of pop or clear equalize, you can have fullness and it’s literally a pressure problem.

Dr. Liu:

We’ve all, or maybe not all, but most people have been to a concert or gone to a basketball game or a movie where there was a lot of noise, right? And you come out of that and for a few minutes or maybe even a few hours or hopefully not, but a few days, it can feel muffled. It can feel blocked. Sometimes you get little ringing and at some point, all of a sudden, most of the time it all of a sudden clears and everything feels better. So, you know, sometimes it can be the inner ear reacting to or acting up in a certain way. So really any part of the ear can give you a sense of fullness as well as somebody who over clenches and grinds and just has a lot of muscle tightness or tension. So all of that can give you fullness.

Dr. Liu:

So this, the feeling of fullness can be from a bunch of different things, right? And one of which you mentioned certainly is migraines. So migraines, people classically think about if you look at a textbook, you’ll find kind of throbbing or stabbing pain, usually centered, kind of behind one eyeball. A lot of people will get what’s called a prodrome or an aura where they kind of feel off and feel like something’s about to happen. They get for a few hours, very dramatic discomfort. They’re sensitive to light, they’re sensitive to sound, but that’s kind of the classic migraine. Migraine is one of those things that honestly can show up at in almost any way. So in the last, I wanna say about 10 years, we’ve really come to understand that migraines can affect the ear as well. I mean, it can affect a lot of other areas of the body, but specifically when it comes to the ear, a lot of people who come in with a sense of imbalance or dizziness can actually be having migraines.

Dr. Liu:

Even if you’ve never had that classic migraine, even if you don’t have the aura, the light sensitivity, sound sensitivity. If You’ve never had it in your life, the dizziness or the fullness in your ear could still be a migraine. The other confusing thing is the headaches and the ear symptoms don’t even happen at the same time. Most of it. So, let’s say you fairly predictably get migraines at a certain time of the month or a certain location you might off cycle from that get random bouts of dizziness. They don’t have to be together. Exactly how and why it happens? I mean people have a lot of theories as to what ultimately physiologically causes migraines and there are a bunch of theories. But really the best way to figure out if your ear issues or your balance issues are from migraine is to make sure that nothing else is going on. We don’t want to just kind of blanket assume that somebody’s come in as a migraine. And if you treat it like a migraine, so if somebody starts to feel the symptoms, then you give them Imitrex. And it breaks the cycle. That’s usually your clearest indication that your best bet is that that’s what’s going on.

Dr. Pearce:

Now as far as in your office or your clinic, is that the standard kind of follow up with patients? So if a patient comes in with dizziness and you’re suspecting migraine, start them with a medication kind of regime to see if it breaks the cycle.

Dr. Liu:

Yeah. So I guess I’ll start with when somebody comes into the office they almost never come in with an actual diagnosis. So very few people say I have vestibular migraine, or I have a vestibular neuritis or an acoustic neuroma or whatever. They usually come in with a symptom and they may say I’m dizzy, or I have vertigo. So one of the things that we kind of struggle with is those terms can mean a lot of things to a lot of people. So a lot of times we try to right at the beginning, get a better understanding of what they’re feeling. So is it outright spinning? Is it just a sense of imbalance or wobbliness is it lightheadedness? And I feel like I’m gonna pass out, is it just that I’m clumsy and I feel like I’m tripping all the time?

Dr. Liu:

Right. there are a bunch of different ways that people use those terms of dizziness and vertigo and depending on which one that you have, it really points to different possibilities of what might be causing it. So coming in and saying, I have vertigo is just the very beginning of a conversation. So for example, if somebody is getting lightheaded all the time, that’s probably not an inner ear problem. If somebody spinning, it’s much more likely, but it’s not a guarantee. So the workup at the beginning, usually it’s just to much better understand what exactly is happening. Is it constant? Does it come and go? Does it last seconds or minutes? Is it associated with, let’s say, head turns or head movements or rolling over in bed? And so it really boils down to we almost always want to make sure there’s nothing super evil, bad, scary, dangerous going on first before we say, aha here, try this migraine medicine.

Dr. Liu:

Right. It’s most people are going to be most afraid of neurologic issues, you know, do I have a brain tumor kind of problems? Is there an infection? The cardiac issue. So heart problems or heart rhythms or let’s say narrowing or clot in the carotid arteries, those are the things that might be very dangerous. So I feel like those are always the things that we first want to rule out. After that we can then start trying to let’s say workup or treat allergies or migraines. Cause then you know, nothing terrible is going to happen.

Dr. Nava:

Just for my own clarification. So when you have this patient with migraine and then now they’re treated for you give them medication and everything’s ruled out and they still have this, you know, this residual dizziness cause that’s, we see a lot of those patients. So I’m just very curious what you do with them to treat their dizziness related symptoms in regards to after everything’s been ruled out, they’re medically cleared, but they’re still having this dizziness. They’re having this visual disturbance with things moving around too quickly. It’s this more hypersensitivity and whatnot. So what do you do with that patient at that time?

Dr. Liu:

So, after we’ve ruled out anything serious and you know, whether it’s migraines or allergies or if you, if you’re doing the simple straightforward things to try to manage those, and yet they’re still symptomatic. It could just be that it’s not managed as well as you want it to be, but it could also mean that something else is going on. So going back to earlier sense of balance or imbalance, I mean it’s affected by so many things. So sometimes there’s more than one issue going on.

Dr. Liu:

So it doesn’t mean you have migraine and you can’t have anything else. Right? So it’s diving a little bit into, are we missing the boat? Maybe the migraines were the majority of what was going on, but there’s something else kind of lurking in the shadows somewhere. Right? but a lot of these problems are more chronic, right? It’s not something that you cure with a shot or a procedure or a pill. It’s something that you need to manage. So even migraines, people have different triggers for migraines. And whether you take medications to try to prevent episodes from happening or to stop them as soon as you start noticing, we do want to get into diet, lifestyle type issues. But fundamentally a lot of times it can cause a more chronic let’s say interruption or disruption of how the inner ear is working.

Dr. Liu:

And that’s when a lot of times you guys come in, right? So the vestibular testing or balance testing kind of as a broad term has a lot of different components, but, and you, you can talk about that in more detail than I could probably. But they really can point to and suggest exactly what parts of your kind of balanced system need help. And so the testing could help kind of dive into maybe what’s happening. And then from that then there’s therapy, right? And balance therapy. I mean I think historically has been physical therapists or occupational therapists that may have some interest or expertise in it. But obviously you guys do a lot of vestibular balance therapy as well. And so with the diagnostic testing, it certainly can launch into very directed or focused therapies or treatments to help people either get back some of the function or to compensate for the problems that they have.

Dr. Nava:

I love that answer!

Dr. Pearce:

Yeah. Cause I always say I have a special place in my heart for migraine patients and the classic migraine suffer, I get the, you know, classic headache and hypersensitivity. But I think one of the most common misconceptions is that it is a pill. You take a pill, the migraine goes away and not really understanding the big picture of the management and the lifestyle changes and even dietary restrictions or modifications. So I think that’s really important for people to hear is that it’s very collaborative and it’s comprehensive and it’s management versus treatment. Because I think that is one of the biggest things that kind of gets, once you fall into that chronic pattern of dizziness or visual disturbance, it kind of gets them trapped and just very debilitating.

Dr. Pearce:

I think that’s such an interesting, you know, for me it piques my interest because it is such a complicated and very new. I’m just kind of understanding I think for a lot of people as far as what can be done for vestibular migraine. So I think that’s always a good one to touch on.

Dr. Nava:

So, we talked about allergies, sinuses, migraines. Is there any other type of condition that you see that dizziness plays a significant role in at your practice?

Dr. Liu:

So one of the most common, and in a way was the most straightforward causes of vertigo or spinning sensation is something called BPPV or benign paroxysmal positional vertigo. And that long-winded name kind of describes it. So benign, it’s not evil, bad security, dangerous. And that infection is not a tumor. Paroxysmal, come and go. Positional, hey, when I move certain ways or put my head in certain positions. And vertigo, kind of the spinning. And it always sounds like voodoo when I’m describing this to patients. It’s like some weird kooky nut job kind of thing. But the semicircular canals that detect rotation of the head have, fluid in those little arcs or those little curves. And part of that sensory mechanisms involves this little gelatin layer with some calcium crystals on it. I know. And it already sounds crazy, right? And every once in a while those little crystals get kinda dislodged.

Dr. Liu:

And as you turn your head, what’s supposed to happen is the fluid sloshes around your right ear tells you, Hey, your head’s turning right. Your left ear tells you, Hey, your head’s turning right. Everything matches up and you don’t get dizzy. But those little crystals sometimes get loose and they start floating around. So when you turn your head, the fluid goes like it’s supposed to. But then you still have these little things floating around sending a signal that now is saying, Hey, the right ear signal and left ear signal don’t match. And they don’t match each other. They don’t match what your eyeballs are telling you. And Holy cow, you feel like you’re spinning like a top. And it almost always happens where there’s a few seconds of a delay between turning your head and the spinning, kicking in. It almost never lasts with each spin or each turn more than about 20, 30 seconds.

Dr. Liu:

You’d never have hearing loss. You never have ringing, you never have any other symptom. Certainly can make you vomit. Certainly it can sometimes trigger almost an anxiety or panic attack. But in the truest sense, it’s just I turned my head a certain way and I spin like crazy for 20, 30 seconds and it stops and it’s repeatable. And most people notice it when they’re rolling over in bed in the middle of the night or getting up in the morning. The most dramatic head movement that can trigger it is almost like looking up and back. So imagine you’re a driver and you’re turning to yell at the kids in the back seat. Not that I ever do that. Now I made the comment, it’s not going to kill you. It, while certainly it can kill you if you’re driving and you turn your head and it kicks in.

Dr. Liu:

Right. so BPPV is a very common problem. Sometimes triggered by a bonk to the head or even just a mild little bump or fall. It could happen in almost any age group. It can happen by itself or sometimes even if you have other conditions going on, you can have BPPV kind of superimposed on top of that. And it’s a very simple maneuver in the office to prove that that’s what you have. Even though just taking that history, you pretty much know. Right. so when somebody calls our office, we have a little triage tool where our staff just ask yes, no questions and if it really sounds like it, it really helps us kind of plan and schedule accordingly. So in the office quick, little five, ten second maneuver almost always tells you what you have. There are other maneuvers that can be done depending on which semicircular canal is affected, that then can help dislodge or get those crystals out of where they’re causing issues.

Dr. Liu:

Sometimes one maneuvers, all you need. Other times you kind of repeat it. A lot of people who get BPPV once, never get it again. But there are people who get it again and again and theoretically anybody can do the maneuvers. ENTs, neurologist, even ER docs. But you know, a lot of patients show up in the ER with this and they ended up getting this whole stroke workup. They get MRIs in their head, they get admitted for a couple of days and all they needed was a little maneuver. So you know, certainly I know it’s something that it can also be very obvious when it comes to the balance and vestibular testing. And as a very, in the classic, let’s say posterior canal BPPV straight forward maneuver. But when you have those other more exotic variations, that’s absolutely something that we depend on people like you to kind of manage. At the end of the day, if all you need is the maneuver, you don’t need to go to the doctor’s office for that. So that’s something that certainly people can come to you and get that taken care of cause you don’t need anything else. You don’t need to go to a doctor’s waiting room and deal with like that coughing, hacking sick person next to you.

Dr. Nava:

Yeah, everyone’s typically terrified when we see them for positional vertigo. They’re scared to even go back in the position because of what’s already happened or whatnot. They don’t want to go through it again. So they kind of build up this anxious feeling for it. I cannot get over how we already have been talking for 40 minutes. I feel like you’re a very professional podcaster. Have you been on a podcast before?

Dr. Liu:

I have never been on a podcast before. But I listen to a lot.

Dr. Pearce:

I love it. Yeah, it’s definitely it. There’s a lot of information. Having somebody, obviously with your extensive experience and education be able to make it very applicable for our audience is such a huge resource. I think that it’s just amazing that you were able to come on and chat with us a little bit, but really make it very user friendly and very you know, general and easy to digest as far as information. So kudos.

Dr. Liu:

And you know, happy to be here and happy to help. You know, we talked about a lot of the kind of, let’s say bread and butter and more common. There are certainly are much more exotic and rare, even your nose and throat are inner ear issues that can lead to a sense of imbalance. I threw out some of the terms earlier, like semicircular canal dehiscence and, and Meniere’s disease. So it’s definitely something that sometimes is very straight forward, but because of the complexity and all the multi-organ systems that may be involved can be very complex. So it’s a team sport. You know, we depend on people like you to help with the diagnostics and even some of the therapy and management afterwards. We sometimes have to collaborate with radiology, with cardiology, with neurology, the primary care doc to kind of tie all of it together is also very important as ENT’s, you know, let’s say it is a migraine for example, right?

Dr. Liu:

And we give somebody Imitrex and it helps break the cycle. ENT’s don’t generally manage chronic migraine or severe migraine, so we might partner up with the primary care doc or even just give it outright to the neurologist to manage from there. So obviously you don’t want to be overly simplistic about balance. There’s a lot going on. And because of that, certainly appreciate how absolutely frustrating it can be for patients who are very debilitated sometimes with these symptoms and they get bounced around from one place to another cause nobody can put it all together. Right. So I think any education that we can give about it and help people understand a little bit better is key.

Dr. Nava:

So where can patients find you? What’s your Instagram? What’s your YouTube, cause I know you have them.

Dr. Liu:

So I’m trying to be kind of sorta hip. I can’t say trying to be young — that ship has sailed. I do have a series of YouTube videos, just me standing in front of a camera with some pictures and videos describing a lot of ENT problems. So it was just Gene Liu MD. It’s the same handle for Instagram. I don’t do as much with that. I’m not posting a bunch of little selfies and trying to be some social media influencer that way. Though, if anybody wants to give me free swag, you know, I’m all for that. What else? I mean those are the, the best ways to kind of look for more content. The YouTube channel is kind of my little pet project. I started about a year ago, I think I have something around 40 videos, all sorts of ear, nose and throat issues.

Dr. Liu:

You tend to at cocktail parties get inundated with the same questions again and again and again. Or you know, like the BPPV spiel I gave you. Right. I give that talk all the time, so I should probably make a video about that so that, you know, let’s say you’re a patient, you come into the office, I see you, I give you the spiel. By the time you walk out, you’ve probably forgotten half of it already and a week or two later, forget it. You’ve forgotten almost everything. And then your brother, sister, father, mother, son, daughter, friend, colleague, whatever they want to know or want to help take care of you or manage and they weren’t there at the visit and then you get a phone call, an email. So it’s my little way of trying to educate everybody about ENT problems because it really is kind of a black box up here where people in general have trouble figuring out what’s happening because it’s not as straightforward as, you know, I banged my knee. The symptom of even like I said, ear fullness can be all sorts of things, right?

Dr. Liu:

Balance can be all sorts of things. So people come in with symptoms but no clarity on what’s going on. And so just trying to help.

Dr. Nava:

Yeah, I feel like that’s a perfect lead-way to you coming back onto the show, which is going to be incredible. But that’s sadly all the time that we have.

Dr. Pearce:

I think it’s wonderful. So I mean, thank you so much again for coming on and we’ll sign off from here. So thank you so much for coming and helping us Dive into Dizziness. That’s the whole point of all of this with more education and resources for patients. And I’m going to let Dr. Nava take it away as far as our contact information and our next followup and next podcast will be more information for patients from a therapeutic standpoint.

Dr. Nava:

Everybody can find us on www.dizzyandvertigo.com. See you soon. Bye.


Deep in Dizziness offers important news, solutions, and advice to help those facing the challenges of dizziness, vertigo, and balance problems live a happier life. To reach Dr. Brook Pearce and Dr. Chelsea Nava, call (310) 954–2207 or visit them online dizzyandvertigo.com.

Dizzy & Vertigo Institute

Improve your balance. End your dizziness. We’d like to help you in person, but we’ll happily assist you through our writing first.

Dizzy & Vertigo Institute

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Improving the outcomes of patients with chronic dizziness, vertigo, and other vestibular problems. Visit our website for help: https://www.dizzyandvertigo.com/

Dizzy & Vertigo Institute

Improve your balance. End your dizziness. We’d like to help you in person, but we’ll happily assist you through our writing first.

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