Concussions, Superior Canal Dehiscence, and Hyperacusis with Dr. Glen Zielinski | E30

Dr. Glen Zielinski from Northwest Functional Neurology explores commonly missed vestibular lesions that can develop after head impacts, focusing on Superior Canal Dehiscence (SCD) as a frequently overlooked cause of debilitating hyperacusis and other post-concussion symptoms. He shares diagnostic insights including a simple tuning fork test that can identify potential SCD cases.

• SCD creates a resonant cavity near hearing apparatus when the thin bone covering semicircular canals is damaged
• Simple tuning fork test on the knee can identify SCD when patients hear rather than just feel the vibration
• Proper diagnosis requires high-resolution temporal bone CT imaging
• Midbrain dysfunction often presents with combined symptoms of light/sound sensitivity, anxiety, and vestibular issues
• Hear the story of how Dr. Zielinski's clinic won architectural awards for its therapeutic design specifically engineered for brain injury patients
• Special features include specific shades of green for photophobia and felt materials that absorb aggravating sound frequencies
• The physical environment itself becomes part of the treatment approach

You can learn more about Dr. Zielinski's clinic at northwestfunctionalneurology.com or email info@northwestfunctionalneurology.com.

Get 20% off your first order of Puori protein with code LIFEAFTERIMPACT by following this link.

Chapters

• 0:00 Vestibular Lesions After Head Impact
• 0:19 Introduction to Life After Impact
• 1:16 Hyperacusis and Superior Canal Dehiscence
• 5:16 Diagnosing Vestibular Issues
• 9:00 Midbrain Issues and Sensory Sensitivity
• 14:37 Finding Treatment for SCD
• 15:17 Therapeutic Clinic Design for Brain Injury
• 20:37 Gustav the Goose and Clinic Life
• 26:17 Final Thoughts and Contact Information

Transcript

Dr. Glen Zielinski: 0:00

But if you're somebody that like fell and hit the back of your head on concrete or something like that and everything goes south, or fell on the ice and stuff like I mean, if you smash the back of your head, it's really, really common that you wind up with stuff like STD and hard vestibular lesions that people miss. That's just not that rare.

Dr. Ayla Wolf: 0:19

Welcome to Life After Impact the concussion recovery podcast. I'm Dr Ayla Wolf and I will be hosting today's episode, where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information, whether you're dealing with a recent concussion, struggling with post-concussion syndrome or just feeling stuck in your healing process. In each episode we dive deep into the symptoms, testing, treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. What other things are you doing for hyperacusis, specifically Because I know that plagues a lot of people that have had concussions?

Dr. Glen Zielinski: 1:28

Well, okay, so when you look at what happens with hyperacusis, there are a few situations that I actually see quite a bit that people missed, and one of them is something called superior canal dehiscence. And the idea of SCD is that. So your vestibular system has semicircular canals and otoliths right, and the semicircular canals are these little fluid-filled tubes, these little hoops with hair cells and fluid, and the idea is that when you turn your head quickly, it takes a second for the fluid to start to move. So that bends hair cells, tells your brainstem hey, my head's turning this way so it can fire appropriate responses. There's three of those on each side, and the anterior canals, the superior canals.

Dr. Glen Zielinski: 2:15

The bone at the top of those canals is really thin, like it's. You're lucky if it's a millimeter thick at the best of times. And, and the thing is, these are pressure-sensitive systems so they need to be encased in bone and for a lot of people and this is pretty common with tall, thin women for some people they don't even have bone there, they just have a bunch of membranes. They never fully knitted that chunk of bone together and it's just a pile of soft tissue, it's just thick connective tissue. Now the thing is, if you stub your head, like if you smash your mastoid bone or something like that, you can blow the top off that bone or you can pop those membranes and create a little fistula, all right, and now what you have is a resonant cavity, and that resonant cavity can make everything loud. And generally, when people have something like this, they don't just hear the world loud, they also hear like their voice loud inside their head and they get things like pulsatile tinnitus, they can hear their heartbeats and they look like they've had the world's worst concussions because they just can't respond to any sensory stimulation. And there's a really simple test to figure that out. And and they're also like super pressure sensitive and altitude sensitive and stuff like that. And the test is you just take a tuning fork and you tap it and you get it vibrating, but have it vibrating just just slightly and then pop it on their kneecap and ask if they can hear it, because they shouldn't be able to hear that, they just only be able to feel it. But if you have a resonant cavity that's developed around there, then all, then they're going to hear that vibration. They're going to hear the tone, then all, then they're going to hear that vibration. They're going to hear the tone right now.

Dr. Glen Zielinski: 3:46

The thing about scd that's a surgical fix. All right, you can do a bunch of stuff to try to stabilize all the consequences of that, but unfortunately those are, that's just. That's a surgical issue. Um, there was a surgeon in portland back in the day who was one of the people that discovered scd and did more SCD surgeries than anybody on the planet and everything else. And then when he retired, the guy that took over his practice was the top SCD surgeon in the world. He's out of records now, but he used to send me all of his patients for rehab and vice versa, and he was telling me that SCD has an extremely high mortality rate and the mortality rate is just from suicide, because people just can't stand all the input and they can't stand the sound and it's just totally crazy making for them and stuff like that.

Dr. Glen Zielinski: 4:33

Right, and the reason I'm harping on this diagnosis is that if this is what you're dealing with even though skull base surgery sounds like a terrible thing for it to put anybody through you wake up after the surgery and you feel like yourself, like it's a game changer. If that's the deal, okay. So there's that. There's also a condition called a perilymphatic fistula, which is a variation on the same theme. That sets people up for tons of hyperacusis. My point is that both of those are hard lesions and they require some pretty thorough diagnosis and they're extremely commonly missed, like we see.

Dr. Ayla Wolf: 5:10

I see a bunch of these people all the time and they've usually seen 20 plus providers by the time they get in to see us and then, in terms of getting an actual specific image of the inner ear to try to diagnose that, can it still get missed on an MRI?

Dr. Glen Zielinski: 5:22

MRI? Absolutely, because the MRI is the wrong image. So what you need to do is a high resolution temporal bone CT that also looks at the internal auditory canal, and that's an image where they do these tiny fine little cuts, like half millimeter slices going through, and they orient the beam so that you can actually see it. And if you see the images on these things, you'll literally see here's the hoop, here's this bone, there's a chunk right there that's missing.

Dr. Ayla Wolf: 5:49

Got it. That's another reason why, again, some of my patients they're like well, I got a specific MRI for my ear and it was normal, and yet they're still having all these symptoms that are just, yeah, kind of smells like SCD.

Dr. Glen Zielinski: 6:07

Yeah, scd is really is really really common. Right, and again that when I when I say really common, it's really common in my practice, because you know my practice, kind of self-flex for the stuff that nobody else gets to fix right but um, but the thing about that, I mean it's still considered to be a rare condition but if you're somebody that, like, fell and hit the back of your head on concrete or something like that and everything goes south, or fell on the ice and stuff, if you smash the back of your head, it's really really common that you wind up with stuff like SCD and hard vestibular lesions that people miss. That's just not that rare. As far as hyperacusis goes, the other things that have a tendency to mess with people, I mean there's, there's a little muscle that basically tightens your tympanic membrane in response to loud noises and that's brain stem driven. And if that, if there's some brain stem pathways that aren't working effectively, then it can be really difficult for you to contract that muscle and, as a consequence, you know like you just can't attenuate loud sounds. Uh, that you can figure out by looking at different cranial nerve functions and see exactly where that issue is and find ways to directly simulate that. I find that that kind of stuff, when we see it, responds really well to specific types of electrical stimulation.

Dr. Glen Zielinski: 7:18

Um, they're one of the things that we see really commonly and this isn't just about hyperacusis, but if you're light sensitive and sound sensitive and visually motion sensitive and you've got tons of anxiety and things like that, and if you're like somebody that you know you drive and you stop at a light and you feel like you're still moving forward and that kind of thing, it's really common that what's happening is that you've got one side of your midbrain, the top part of your brainstem, firing way too high because you can't inhibit it correctly any longer and that can be from a midbrain lesion or that can be from descending basal ganglia problem. Um, and the diagnostics on that. You put somebody in the dark on infrared, you have them look up and you'll see one eye come in and get stuck or go into like convergence, retraction to stagnance or something like that. That area of the midbrain that's wound up in those situations is the primary relay for light and sound and it's the primary output for stress. And people that have that issue they're usually having tons of anxiety and they can't sleep and you know things like vergence.

Dr. Glen Zielinski: 8:23

They always feel like if you look up, you feel like you're moving forward and all kinds of stuff that just doesn't seem to make any sense until you can tie it all together into one little nut and go. That's the area of the brain that needs the help and there's great ways to fix that. I mean, we fix that stuff all day long, but it's. It's challenging to figure out, but once you see it and you know what to do about it, you can usually make that go away pretty quickly I love it, do you find?

Dr. Ayla Wolf: 8:46

so? Okay, going back to the vibration on the knee, are you finding like 100 of the time when someone says, yes, I can hear that. That then when you send them off for the proper imaging that that's what they're seeing is the scd.

Dr. Glen Zielinski: 9:02

I would say 80% of the time that's what we see, and I think that 20% is based on people not quite understanding the instructions on that test. Sure, and the thing is, if you do it multiple times it becomes less reliable. So really, you're looking at, you got to figure it out on the first or second attempt and if you have to explain that to somebody like five times, you're like no, no, no, no. I just, I know you feel it, I just want to know if you hear it right. By the time that's happened you've changed their system enough that it's probably not the most reliable test.

Dr. Glen Zielinski: 9:35

But again, people with SCD, you know you should be able to go okay, you take your tuning fork, you tap it. Now you don't hit it hard, you don't want to give them the big, loud noise, right, but you, you tap it, get it vibrating, put it in your hand. You should be able to tell that you can feel the vibration there. Put it on one side, they don't hear it. Put it on the other side, they hear it. And the side that they're hearing it is the side of the increased bone conduction that comes from having a resonant cavity next to your hearing apparatus.

Dr. Glen Zielinski: 10:03

Yeah, yeah, got it and it's, it's very reliable okay, I'm gonna start using that.

Dr. Ayla Wolf: 10:11

I I've got somebody coming in next week that I need to do this on immediately.

Dr. Glen Zielinski: 10:15

Yeah, cool uh, you'll usually find that with that same person. If you do like you know, like a weber and a renee test, if you stick a tuning fork on that mastoid, they're gonna hate it, they're gonna run for the exit and that right there immediately tells you that yes, you know, there's something hard in there.

Dr. Ayla Wolf: 10:35

If they've got that, plus the, the resonant cavity thing, then you'll know yeah, now there aren't very many surgeons that actually perform that surgery are there uh, there, let's put it this way there aren't that many good ones.

Dr. Glen Zielinski: 10:49

Um, the thing about that third, I mean it's you know, it is neurotology, so anybody that's trained in skull base surgery should at least you know I mean, they'll be aware of the procedure. But this is the kind of thing where you want somebody that's really good at it. So I was talking about, um, uh, a dude named Ashley Wackham, who's, yeah, and Wackham's an interesting name for a surgeon, right? But, uh, he was in Portland, he'd done more STD surgeries than anybody on the planet, and then his, then his daughter, moved to Jersey. So he was like, all right, well, let's just take a chair at rutgers and off he went.

Dr. Glen Zielinski: 11:26

So, I mean, I have lots of patients where, if it's something complicated, like something seriously complicated, I'll still send him out to jersey and have them go and see, see ashley, and he'll put them back together and that's a challenge, because they can't fly, because altitude messes them up right and after the surgery they can't fly for like basically a year, because you need to make sure that that the bone patch that they're putting in has an opportunity to fully stabilize, and stuff like that. So they're like taking the train to get there and stuff like that, but anyway, but they come back and they're in different humans yeah, wow.

Dr. Ayla Wolf: 13:14

and then tell me a little bit about your clinic, because when I I got to shadow you, you were at your other clinic and since then you have bought this building and completely remodeled it in a way that you were really thinking about your patients and their experience as you created this amazing place. You've won two different architectural awards the Best Small Healthcare Facility Award of 2020 by the International Interior Design Association, which is the highest award somebody can get, as well as the Honor Award of 2022 from the American Institute of Architecture. So tell me all about your space and the thought that went into it.

Dr. Glen Zielinski: 13:55

So tell me all about your space and the thought that went into it. The thought that I ended with was what do you mean? It's going to be a million bucks, okay, so here's the deal. So I bought this building at the end of 2016. And actually on my birthday in 2016, I gave myself a multi-million dollar birthday present. Like actually on my birthday in 2016, I gave myself a multimillion dollar birthday present. And then, yeah, so my wife's been looking at me going like, so what do I get? What do I get? But anyway, so did that, thought I'd be in by the middle of 2017. And we didn't get in until the end of 2018 because we gutted this place and we ripped it apart.

Dr. Glen Zielinski: 14:36

And when I first started and the design process, I found these architects that were just, you know, the coolest architects I could find. They'd done like some of my favorite wineries and they did a spectacular job on a friend's house and stuff like that. So I hooked up with them and told them what I wanted, told them what I'm you know, the place was about brain injury and stuff like that and they're like, okay, we'll get back to you. And then they ghosted me and I didn't hear from them for like three months. And I was just about to sign a contract with somebody else when they called me up and they're like okay, we got it, we need a meeting. And they came in and they presented this amazing thing to me and I was like that's mind blowing. Can we do this? No, how about this? Can I move this over here? No, can I do it. And then they just cut me off and they're like you don't understand. We spent the last three months combing the literature to figure out exactly what it means to have a brain injury and, for example, we figured out that there's this one Pantone shade of forest green that in the literature has been shown to be the most calming for people that have got photophobia. And then we figured out that the literature says that the auditory frequency that tends to be the most aggravating for people with hyperacusis is like 2.4 kilohertz or something like that. And then we found this company in Germany that makes this felt that we can get made in that color that absorbs at 2.38. And I'm like wrap the clinic in it. And they're like well, that'll be half a million bucks. And I'm like wrap half the clinic in it, you know, et cetera, et cetera.

Dr. Glen Zielinski: 16:02

So my, my building used to be a Starbucks, which was interesting because it smelled like coffee for a year, but, um, but it has this huge atrium with, like you know, a 40 foot ceilings or 45 foot ceilings and windows up top and all this stuff and somebody with vertigo I mean, that's the waiting room right Somebody with vertigo sitting in that space. They would just melt down, they'd have a panic attack, right? So what these guys did was they built like this virtual reality model of the space and then they found this way to create vertigo simulating software and they put the software on and then they walked through the model and they found every space in the building that was messing with them and giving them vertigo, and then they just played with the shapes until it was gone, right? So if you walk in and you sit in this atrium, you'll see like there's this whacked out shapes with all these bizarre floating light towers that they built. So I've got like this big light thing that covers about two thirds of the the atrium space. So you still have the ambience, you still have the height, you still have the natural light and everything else, but then there's this weird, bizarre shape that I can't even describe, and it's a light cloud and Tim the architect was just sitting there going like bending it until until it made him stop wanting to puke it there, going like bending it until until it made him stop wanting to puke.

Dr. Glen Zielinski: 17:26

Okay, that's the shape. And then it was like let's do that with a coffee table and let's let's put plants in the coffee, and and anyway. So they did that through the whole space. Um, and, and it's amazing, I mean like people walk in to my clinic like the thing about this space is that it's actually it's a therapy. The space itself is a therapy, all right, and and it's spectacular in that regard, um, people walk in. You can just see as soon as they walk in for the very first time, because they're in like meltdown mode, they're in full, you know sensory flooding, overwhelm mode and everything else, and they walk in and they close the front door behind them and they look around and then you can just see people have their first deep breath since their, their injury, you know, they just they just like chill and the space is just incredibly therapeutic, you know wow I I did.

Dr. Ayla Wolf: 18:15

I didn't know that was going to be such a cool story. I thought you were just going to say oh yeah, we, you know, dim the lights a little bit. That turned into a whole other story.

Dr. Glen Zielinski: 18:23

Oh yeah, no, it's great. You need to come and hang out and check it out.

Dr. Ayla Wolf: 18:29

I want to you also have a big pond in the back too, right?

Dr. Glen Zielinski: 18:33

Yeah, so I own a lake, which is sort of weird. I never expected to be able to say that. So we have our big waiting room up at the front. That's where all the pseudo chaos is, and actually I think the biggest compliment I can give the architects and the designers is that it's extremely common that we'll just be totally slammed, completely running our asses off 45 minutes an hour behind the staff is just in battle mode, and then I'll get into a room with a patient. They'll be like oh, you guys aren't very busy today, are you?

Dr. Ayla Wolf: 19:09

Wow.

Dr. Glen Zielinski: 19:11

You know what I mean, because, because the space is just chills, everything. It's amazing, right, but but, but anyway. So in the back we have we built a specific lounge just for our intensive patients, right, and that faces out onto the lake. So it's like this crazy idyllic space, you know, and everybody goes and hangs out outside. We had a goose named Gustav who was a Lake-as-we-go legend. He was the Chinese goose. He'd been living in the pond or the lake or whatever you want to call it, forever. I mean, they're only supposed to live about 12 or 14 years, something like that. He was there for like 23 years.

Dr. Glen Zielinski: 19:50

Everybody knew gustav and um, then gustav unfortunately got taken down by a coyote last year and everybody in town lost it, you know. I mean he was getting like written up in the local papers and stuff like that, and I was like, well, I can't let that stand. So I had to get another goose. And then somebody told me you know, gustav had a mate for years and they just followed around. So then I was like, okay, I guess I gotta get gustav a mate.

Dr. Glen Zielinski: 20:20

And then I was on this website looking up how I, you know, like promote shipping for keys and I saw these things called runner ducks. I'd never seen a runner duck in my life. They're the. They're the most ridiculous, hysterical looking things you'll ever see in your life. They're like little t-rexes that run like this, oh my gosh. So next thing you know, next thing you know, I have like eight runner ducks right and and unfortunately somebody pointed out to me if they're not wild, you can't just cut them loose because they're not waterproof yet you have to keep them indoors for six weeks. So I had eight ducks and baby geese in my garage and I would never advocate anybody do that because, oh, but anyway. So ultimately, yeah, ultimately, I pawned them off on a staff member and they were able to raise them for the last couple of weeks.

Dr. Glen Zielinski: 21:11

But now?

Dr. Glen Zielinski: 21:11

So the point is that they all live up in the, in the, in the pond, and I'm using them as, uh, a great. I almost use them diagnostically, because my primary exam room, where I meet all my new patients, is at the back of the clinic. So there's like here's the intensive lounge, there's this little hallway, then here's my space, and there's steps right here going out into the pond, and they've figured out that anytime they hear somebody that's not I don't know if it's about hearing, you know, maybe they just do it all the time anyway because they figured out that anytime they hear somebody I don't know if it's about hearing, maybe they just do it all the time anyway because they figured out that it's going to work for them. But Gustav and his wife, gustav Jr and his wife and now their kid, they have a baby they sit out there and they just honk at us nonstop.

Dr. Glen Zielinski: 21:59

So if I'm in with a new patient I can immediately be able to tell if they can inhibit, because there's Gustav like screaming at us, going like I want it you get out here and feed me now, right?

Dr. Glen Zielinski: 22:10

So yeah, they live pretty fat, happy lives and by the time we're done and you know you can pick them up and stuff like that, they, they love people. So by the time anybody finishes an intensive with us, they're usually taking pictures with the geese and the ducks on their laps and stuff like that.

Dr. Ayla Wolf: 22:27

Oh, that's awesome.

Dr. Glen Zielinski: 22:29

Anyway. So there's that.

Dr. Ayla Wolf: 22:31

Wow, what an incredible experience that you've built.

Dr. Glen Zielinski: 22:34

Yeah, well, it's been uh, it's been a long time coming, but it's a pretty fantastic space. And, again, you know, we have every conceivable form of therapy. We've got two rotational chairs. We have, you know, like a full physical therapy suite, a full, I mean I I had a, you know, still do have a gig with um, like sock pack and with the navy seals. So we built like this big rehab space for when I get to work with, you know, special forces guys and stuff like that and um, that's proven to be a lot of fun, because now when I talked about our last gig in that therapeutic process, integrating stuff, that's where we just have this massive space to just with, like you know, 20 foot ceilings, to just go and do whatever the heck we want with people, and that involves all kinds of things that are super entertaining for us and it takes a little bit too long to describe, so we'll punt on that.

Dr. Ayla Wolf: 23:29

All right. Well, if you need an assistant next time they come through, I'm there.

Dr. Glen Zielinski: 23:33

Yeah, fair enough.

Dr. Ayla Wolf: 23:37

So you know what happens when you and I get together, though. Right Well, you get kicked in the head, yeah.

Dr. Glen Zielinski: 23:42

Yeah, yeah, yeah, yeah, that's's it. So I don't know how many of your listeners or viewers know this, but it was pretty accomplished martial artist. I so am I, and anytime we wind up in town together I get to discover the glory of her fadeaway head kick.

Dr. Ayla Wolf: 23:58

It's spectacular I'm old and stiff now. I don't think my, I don't think my leg's going to reach anymore, sorry.

Dr. Glen Zielinski: 24:07

Still, dude, it's spectacular. Nobody's landed that on me in years, other than you.

Dr. Ayla Wolf: 24:11

Oh well.

Dr. Glen Zielinski: 24:12

So anyway, there's that.

Dr. Ayla Wolf: 24:16

Awesome. Well, I would love to come see your new space.

Dr. Glen Zielinski: 24:19

Fantastic.

Dr. Ayla Wolf: 24:22

All right. Well, how can people find you?

Dr. Glen Zielinski: 24:25

uh, well, uh, so we're in lake as we go argon, which is basically, you know, suburban portland. Um, our website is northwest functional neurologycom. Um, and, yeah, most people just reach out to us through there. The email is like info at northwestfunctionalneurologycom Website, youtube channel, I mean all that kind of stuff. That's usually where people find us.

Dr. Ayla Wolf: 24:50

Awesome. Well, thanks so much for your time. Enjoy your soiree tonight.

Dr. Glen Zielinski: 24:55

You have a great weekend.

Dr. Ayla Wolf: 24:56

Thank you, thank you.

Dr. Glen Zielinski: 24:58

All right, have a great day you too.

Dr. Ayla Wolf: 25:03

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