Interview with Kamran Barin, Ph.D.

Topic: AudiologyOnline's Vestibular Virtual Conference, June 21 - 25, 2010

Kamran Barin, Ph.D.

SMAKA: Thanks, Kamran, for your time today. Before we get into the topic of the great online conference you organized for us, can you tell me about your background and your current position? Be sure to include in how many countries you've taught vestibular courses.

[Laughter]

BARIN: I'm the Director of the Balance Disorders Clinic at the Ohio State University and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program. I also received my Master's and Ph.D. from the Ohio State University in electrical engineering, but somehow my engineering neurons just left me, and I spent the rest of my professional career in the area of vestibular testing and evaluation. I did my Ph.D. dissertation in the area of posturography, and so that's how I ended up in the vestibular testing area.

I regularly teach courses and seminars around the U.S. in the area of vestibular evaluation. In the last five or six years I've presented at audiology or speech and hearing conventions in 12 states.

SMAKA: 38 to go!

BARIN: Right, maybe over the next 5 to 10 years I will get to the other 38.

I have also had the opportunity to teach around the world. Last year I taught in the U.K., China, and Singapore. I just got back from Iran. This year I will also be teaching in Brazil, then China again, Australia, perhaps Indonesia, Turkey, and a few other countries.

SMAKA: Wow. Do you wake up in the morning and wonder what city or country that you're in?

BARIN: Last year that exact thing happened to me. I taught a three-day course in Chicago and then that night I flew to China. I arrived in China 24 hours later at 10:00 p.m., went to bed, and got up 6:00 a.m. I taught the whole day and then went to bed, got up 6:00 a.m. and flew to Singapore. I arrived in Singapore at 2:00 a.m. and when I woke up the next morning at 6:00 a.m. I wasn't quite sure where I was and why I was there. It took me a minute to realize I had to do another two days of teaching in Singapore. After my course finished in Singapore, I had a presentation scheduled at the New Hampshire Academy of Audiology here in the States, but I didn't have time to stop at home. So, I flew from China to Chicago and then directly to New Hampshire before coming back home.

I had a lot of dirty laundry by the time I was done with that trip.

[laughter]

SMAKA: I'm jet-lagged just listening to you talk about all the places that you've taught!

But, I do have a few questions for you. The first is, how did you decide on which particular experts to invite to present in the upcoming AudiologyOnline Vestibular Virtual Conference?

BARIN: I was looking for cutting-edge individuals in the area of balance. I also thought it was important to have different topics throughout the week, including emerging areas of balance testing and vestibular rehabilitation. I was very fortunate that the first group of individuals that I approached all accepted. These individuals are well-known in their areas of work and will be presenting on different areas of balance so that all of the presentations complement one another.

SMAKA: In looking at the program, it seems to me that all the presenters have done extensive research and publishing, but at the same time, the topics they are presenting on seem very practical.

BARIN: Yes, I think you often see that in the area of balance testing. Most people who attend courses or seminar are looking for practical information. Obviously, this practical information emerges from research. Clinical application comes from the research. The presenters at the upcoming conference have excellent research track records and also can speak about the practical application of their work, and how this information can be used in day-to-day clinical activity.

SMAKA: On Monday we start the week with Bedside Tests of Vestibular Function with Devin McCaslin from Vanderbilt University. Can you touch on what this course might cover?

BARIN: Yes. Bedside tests are a great supplement to the laboratory tests of vestibular function. These tests can be done in the office, in the clinic, at the bedside or in the ER. They give you valuable information such as raw material that can be used for clinical decision-making and at the same time, may help you avoid some of the artifacts and errors that could occur in laboratory testing. These bedside tests can confirm or supplement other testing, and enhance the clinical decision-making process. We're very fortunate to have Devin presenting on this topic, and not just because he's an Ohio State alumnus. He does great work in this area, and I'm really looking forward to hearing his presentation.

SMAKA: On Tuesday, we're thrilled that you're presenting since your AudiologyOnline courses are among the most highly viewed of all of our hundreds of courses. What is the topic of your seminar?

BARIN: My seminar is entitled Getting the Most of ENG/VNG Testing. I'll discuss best practices in performing different parts of the testing and general guidelines about interpretation. I'll talk about extracting the maximum amount of information from the time that you're doing the testing, and at the same time avoiding some of the pitfalls and errors that are quite common with ENG such as over-diagnosing and under-diagnosing. It will be a kind of step-by-step guideline for each one of the subtests as well as covering what to do, what not to do and how to interpret the test results.

SMAKA: That sounds like a must-see. On Wednesday David A. Zapala will be on talking about rotational chair testing.

BARIN: Yes, David is with Mayo Clinic in Florida. He has done excellent work in various aspects of balance testing. One of his areas of expertise is rotation testing. Because this testing is not widely offered, there are not a lot of people with clinical experience in this area. But it's important to know when to refer patients for rotation testing, and what one can expect from the test results. Again, looking forward to hearing from David on this, and we are fortunate to have him as part of this conference.

SMAKA: We have had several requests from audiologists for a course on rotational testing, so it is nice to be able to tell them about this upcoming course.

What's on the program for Thursday?

BARIN: On Thursday, Faith Akin and Owen Murnane will present a seminar on Tests of Otolith Function. Faith and Owen are with James H. Quillen VA Medical Center and teach in the Department of Audiology and Speech-Language Pathology at East Tennessee State University. They have done a fabulous job of introducing vestibular evoked myogenic potential (VEMP) and do top-notch research. It has now expanded further into otolith testing. VEMP, as you know, is one of the tests that currently is becoming much more common in vestibular laboratories, and it has application in otolith testing. Other areas that they will probably address include eccentric rotation tests and subjective visual vertical testing. Faith and Owen are both eminently qualified in these areas and it is a great opportunity to hear them discuss their work. Up until now we could not effectively test the otoliths. These are new and emerging techniques that will be discussed, and if they're not already in clinical use, they will be in clinical use very soon.

SMAKA: We've been mostly talking about testing and diagnostics, but on Friday we have Susan Whitney and Patrick Sparto presenting on rehabilitation.

BARIN: Yes, as far as vestibular topics are concerned, no conference would be complete without discussing management. Sue Whitney and Pat Sparto are both with the University of Pittsburgh and have a long track record of research with practical application in the area of vestibular rehabilitation. Dr. Whitney is one of the pioneers of vestibular rehabilitation and truly an expert in this area. Pat is one of our former Ph.D. students at the Ohio State University, and he also kind of switched directions after getting his degree in engineering. He then went into physical therapy and received a master's degree. He's doing excellent work in novel aspects of rehabilitation, such as use of virtual reality.

I'm very excited to hear their presentation.

SMAKA: On Friday, it looks like the entire faculty will participate in the panel discussion. It should be a great opportunity for professionals to be able to ask questions of leading experts in vestibular diagnosis and management. What kind of topics do you think might come up in that discussion?

BARIN: I can think of a number of questions we may receive, from, "When do I need to refer a patient for rotation testing?" to "What are some new techniques in the area of rehabilitation?" We may get questions about how to manage specific abnormalities, such as those we don't encounter every day, like Mal de Debarquement Syndrome. Since the area of otolith testing is an emerging area, I would expect questions about how this applies to audiologists' specific practice settings, what testing they should or should not offer, and when to refer patients out for otolith testing to major vestibular centers.

With bedside testing and office testing, this is an area that everybody should be interested in, both as a supplement to other testing and also as independent testing to reduce the need for more elaborate tests. If these tests are done accurately and with the right clinical mindset, they will be a great addition to our laboratory testing. I would expect to see a lot of interest and questions from attendees in this area.

The list goes on. I will have at least an hour of questions myself, but I will try to keep quiet and let our attendees ask the questions.

[Laughter]

SMAKA: It sounds to me that this conference has something for everyone and for audiologists at all levels of experience with vestibular testing and management.

BARIN: Absolutely, I agree. The novice can hear about basic testing, best practices and pitfalls, when to refer, as well as what to expect for management. The professional who is advanced in vestibular diagnosis and management can hear about the latest techniques and new, emerging areas. I'm looking forward to attending each session to hear the latest from these leading experts.

SMAKA: Thanks for planning such an outstanding conference, Kamran. We're looking forward to it as well.