The ear, dizziness, hearing loss and otological symptoms in Parkinson's disease

Picture by Jonny Acheson

We do not often think about the ear and the otological manifestations of Parkinson’s disease. Vestibular issues, dizziness and vertigo are among the most common complaints. We picked the brain of Abhimanyu Mahajan, MD from the Rush Parkinson’s disease and Movement disorders program in Chicago, IL about his most recent research publication in Parkinsonism and Related Disorders. “From 188 consecutive eligible PD patients, 91 had otological symptoms and 97 did not.” His findings raise interesting questions about the ear and Parkinson’s.

Who is the author Abhimanyu Mahajan MD?

Currently, Dr. Abhimanyu Mahajan is an Assistant Professor at the Rush Parkinson’s disease and movement disorders program in Chicago, IL. After medical school, Dr. Abhimanyu Mahajan obtained a Masters in Epidemiology (concentration: aging) at the Johns Hopkins Bloomberg School of Public Health and a certificate in gerontology from the Johns Hopkins Center of Aging and Health. During this time, he also worked as a graduate research assistant in movement disorders. He completed his Neurology residency at Henry Ford Hospital in Detroit, and Movement disorders fellowship at the University of Cincinnati where he was the 2019 Dystonia Medical Research Foundation (DMRF) clinical fellow.

His primary research interests lie in the pathophysiology and clinical manifestations of dystonia. His broader areas of interest lie in aging and the use of epidemiology and imaging in disorders of motor function. He is also interested in graduate medical education. His research has been recognized with the 2018 American Academy of Neurology (AAN) Young Investigators award, the 2018 he was the Parkinson’s Study Group (PSG) junior investigator award and the 2020 AAN Alliance Award: Founders. One of his research interests is the ear and Parkinson’s.

Can you get ear related issues in Parkinson’s

disease?

Image from a recent article by parkinsonsnewstoday

Vestibular dysfunction, presenting as dizziness or vertigo is not uncommon in Parkinson’s disease (PD). People living with PD may have vestibular dysfunction even without experiencing any symptoms. Studies have shown that vestibular system abnormalities may be the sole cause for falls in 10-18% of people with PD.1

Do I need to see a doctor about this?

Parkinson.org image from Parkinson’s Foundation

Given the importance of preventing falls and associated loss of independence,2 it is imperative that people with PD who suffer from dizziness discuss it with their neurologist. Dizziness can be due to many reasons. It may be due to falling blood pressure when you stand up, a primary brain-related cause or an ear-related issue. Any of these can make you feel unsteady and fall, and almost all of these falls may be preventable. Some of the causes of dizziness are reversible. In addition to falls, loss of hearing can affect your attention and has been associated with cognitive impairment.3 Your neurologist may refer you to an ENT doctor for further assessment.

Some of these symptoms started even before my

PD started and much before it was diagnosed, what

does it mean for my PD?

Image from the DefeatPD website

In our study on clinical data from close to 200 eligible Parkinson’s disease patients seen at University of Cincinnati between 2014 and 2020, presence of these symptoms before onset of PD symptoms was associated with slower clinical progression of PD.4 It is possible that such symptoms represent a “prodrome” that indicates a reduced risk of motor progression in PD. This is the first study of its kind to show this and needs to be replicated as our sample was not large enough to draw a firm conclusion.

Can this information be used to slow down my PD?

Auditory strategies have been shown to improve symptoms: timing of gait and associated stability.5 Rehabilitation using Neurofeedback with auditory signals may possibly reduce the risk for falls.6 The information we have currently is not enough to suggest a disease modifying effect and thus needs further investigation.

What more needs to be done? (limitations of our

study)

A variety of symptoms can happen with disorders of the ear, including dizziness, ear fullness and hearing loss. It is important to study these symptoms individually and with input from other modalities like neurophysiology and possibly, genetics. Such an effort would help understand the complex biological relationship between the brain and the ear, and its impact on people living with Parkinson’s disease.

To read more books and articles by Michael S. Okun MD check on Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside

He also serves as the Medical Advisor for the Parkinson’s Foundation.

To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.

The blog artist is Jonny Acheson.

Selected References

1.   Venhovens J, Meulstee J, Bloem BR, Verhagen WI. Neurovestibular analysis and falls in Parkinson's disease and atypical parkinsonism. The European journal of neuroscience. Jun 2016;43(12):1636-1646.

2.         Grimbergen YA, Schrag A, Mazibrada G, Borm GF, Bloem BR. Impact of falls and fear of falling on health-related quality of life in patients with Parkinson's disease. Journal of Parkinson's disease. Jan 1 2013;3(3):409-413.

3.         Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis. JAMA otolaryngology-- head & neck surgery. Feb 1 2018;144(2):115-126.

4.         Mahajan A, Marsili L, Dwivedi AK, et al. Timing matters: Otological symptoms and Parkinson's disease. Parkinsonism & related disorders. Jul 29 2021;90:23-26.

5.         Hove MJ, Suzuki K, Uchitomi H, Orimo S, Miyake Y. Interactive rhythmic auditory stimulation reinstates natural 1/f timing in gait of Parkinson's patients. PloS one. 2012;7(3):e32600.

6.         Rubinstein TC, Giladi N, Hausdorff JM. The power of cueing to circumvent dopamine deficits: a review of physical therapy treatment of gait disturbances in Parkinson's disease. Movement disorders : official journal of the Movement Disorder Society. Nov 2002;17(6):1148-1160.