Breaking Through the Last Frontier

We have spent several years developing a method to deliver vestibulo-active medication to the round window. From the round window the medication will travel to the inner ear. This has been very effective in the treatment of Meniere's Disease, post-traumatic vertigo and chronic laybyrinthitis. Other recent advances are in the areas of immune-mediated diseases and viral infections of the inner ear. Effective treatment is now availbable for these conditions.

With these goals in mind, the POC has remained at the forefront of new advances for years, and continues to do so. Our most notable achievement has been the development of the Canalith Repositioning Procedure, widely known internationally as the "Epley Maneuvers". This has provided a non-invasive, low-risk method for treating benign paroxysmal positional vertigo (BPPV).

The Omniax has been a tremendous tool for diagnosis and treatment of particularly difficult cases of BPPV, as well as other forms of positional vertigo. With it, we are gaining new insight into many vertigo-causing  conditions.

One of our latest developments is the Omniax, a custom-made omni-axial chair capable of placing a patient in any position through 360 degrees, while simultaneously monitoring eye movement with infrared videography. The Omniax has been a tremendous tool for diagnosis and treatment of particularly difficult cases of BPPV, as well as other forms of positional vertigo. With it, we are gaining new insight into many veritgo-producing conditions.

We are collaborating now in a study to develop the delivery of vestibulo-active medication to the round window and thence to the inner ear, for resolving certain inner ear conditions. This is showing great promise in the treatment of Meniere’s disease, post-traumatic vertigo and chronic labyrinthitis. Other recent advances are in the area of immune-mediated diseases and viral infections involving the inner ear. Effective treatment is now available for these conditions.

So vertigo, one of the last frontiers in medicine, is rapidly being conquered. And the POC is a major player in this effort.

As you have probably ascertained by now, there is much controversy regarding balance disorders and vertigo. This controversy involves not only the method of treatment, but the etiology (what causes what), the site of the malfunction (where things have gone bad) and the method of diagnosis. In our opinion, most of this controversy stems from either a lack of knowledge, or a resistance to assimilating that knowledge.

Many recent advances have been occurring so fast that they are being made available by a few specialists before the information has made it through the gauntlet known as the "peer review process". This is a painfully slow process whereby physicians or scientists, usually with their thinking imbued with the existing concepts, pass judgment on new information and concepts before allowing publication in an established journal. This process may reject important information and hold up its dissemination for years.

And even if the new information reaches a medical journal, the output of other medical information is so profuse that important new information may get lost in the shuffle. Or it may be accepted and used by a few specialists who regularly scour the literature within their particular area of interest, yet it still may take years for that information to become widely accepted and used among other physicians.

These problems have been particularly evident with many of the advances with vertigo and imbalance. For instance, in 1985 I submitted a paper introducing the "canalith repositioning procedure", a non-invasive treatment for BPPV, only to have it rejected as "contrary to existing theory". I was finally able to get it published in a major journal in 1992, and it took about 3 more years after that to achieve general acceptance and use. It has now received world-wide acceptance. However, in that 10-year period from 1985 to 1995, there were many unnecessary operations done for this condition, and tens of thousands inadequately untreated, simply because of this delay in information dissemination.

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...for a new treatment to be deemed usual and customary, it must be widely used and applied. And, with the majority of medical treatment now under "managed care", any uncovered treatment cannot be used at all. Does this mean that new medical advances will never become generally available?

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This problem carries through to dealings with medical insurance carriers. They generally have a policy of stubbornly refusing coverage for anything that is not, in their opinion,  "usual and customary". This is a problem with some of the diagnostic and treatment methods utilized at the POC. Because much of our treatment of vertigo is "leading edge" and not yet "mainstream", our patients may encounter difficulty in getting insurance coverage. Some items are not covered by the insurance carriers even though we can show that these methods are more effective, lower risk and less expensive than the "standard" methods.

Further, this brings up the "catch 22" problem. Under "managed care" agreements, patients cannot be treated under any circumstance with a new method until it becomes "usual and customary". But, for a new treatment to be deemed usual and customary, it must be widely used and applied. And, with the majority of medical treatment now under "managed care", any uncovered treatment cannot be used at all. Does this mean that new medical advances will never become generally available?

We don’t have the answer. But we still feel obligated, in spite of the obstacles, to keep these new and better methods available for our patients.

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