August 11, 2025 • 26 mins
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.
Dr. Wolf's book Concussion Breakthrough: Discover the Missing Pieces of Concussion Recovery is now available on Amazon!
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Website: lifeafterimpact.com
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Transcript
Episode Transcript
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Dr. Glen Zielinski (00:00):
But if you're somebody that like fell
and hit the back of your head onconcrete or something like that
and everything goes south, orfell on the ice and stuff like I
mean, if you smash the back ofyour head, it's really, really
common that you wind up withstuff like STD and hard
vestibular lesions that peoplemiss.
That's just not that rare.
Dr. Ayla Wolf (00:19):
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolf and I will behosting today's episode, where
we help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go-toresource for actionable
information, whether you'redealing with a recent concussion
(00:40):
, struggling withpost-concussion syndrome or just
feeling stuck in your healingprocess.
In each episode we dive deepinto the symptoms, testing,
treatments and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
(01:02):
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
you build a better life afterimpact.
What other things are you doingfor hyperacusis, specifically
(01:23):
Because I know that plagues alot of people that have had
concussions?
Dr. Glen Zielinski (01:28):
Well, okay, so when you look at what happens
with hyperacusis, there are afew situations that I actually
see quite a bit that peoplemissed, and one of them is
something called superior canaldehiscence.
And the idea of SCD is that.
So your vestibular system hassemicircular canals and otoliths
(01:54):
right, and the semicircularcanals are these little
fluid-filled tubes, these littlehoops with hair cells and fluid
, and the idea is that when youturn your head quickly, it takes
a second for the fluid to startto move.
So that bends hair cells, tellsyour brainstem hey, my head's
turning this way so it can fireappropriate responses.
There's three of those on eachside, and the anterior canals,
the superior canals.
(02:15):
The bone at the top of thosecanals is really thin, like it's
.
You're lucky if it's amillimeter thick at the best of
times.
And, and the thing is, theseare pressure-sensitive systems
so they need to be encased inbone 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 thatchunk of bone together and it's
(02:38):
just a pile of soft tissue, it'sjust thick connective tissue.
Now the thing is, if you stubyour head, like if you smash
your mastoid bone or somethinglike that, you can blow the top
off that bone or you can popthose membranes and create a
little fistula, all right, andnow what you have is a resonant
cavity, and that resonant cavitycan make everything loud.
And generally, when people havesomething like this, they don't
(03:01):
just hear the world loud, theyalso hear like their voice loud
inside their head and they getthings like pulsatile tinnitus,
they can hear their heartbeatsand they look like they've had
the world's worst concussionsbecause they just can't respond
to any sensory stimulation.
And there's a really simpletest to figure that out.
And and they're also like superpressure sensitive and altitude
sensitive and stuff like that.
(03:21):
And the test is you just take atuning fork and you tap it and
you get it vibrating, but haveit vibrating just just slightly
and then pop it on their kneecapand ask if they can hear it,
because they shouldn't be ableto hear that, they just only be
able to feel it.
But if you have a resonantcavity that's developed around
there, then all, then they'regoing to hear that vibration.
(03:42):
They're going to hear the tone,then all, then they're going to
hear that vibration.
They're going to hear the toneright now.
The thing about scd that's asurgical fix.
All right, you can do a bunchof stuff to try to stabilize all
the consequences of that, butunfortunately those are, that's
just.
That's a surgical issue.
Um, there was a surgeon inportland back in the day who was
one of the people thatdiscovered scd and did more SCD
(04:05):
surgeries than anybody on theplanet and everything else.
And then when he retired, theguy that took over his practice
was the top SCD surgeon in theworld.
He's out of records now, but heused to send me all of his
patients for rehab and viceversa, and he was telling me
that SCD has an extremely highmortality rate and the mortality
(04:26):
rate is just from suicide,because people just can't stand
all the input and they can'tstand the sound and it's just
totally crazy making for themand stuff like that.
Right, and the reason I'mharping on this diagnosis is
that if this is what you'redealing with even though skull
base surgery sounds like aterrible thing for it to put
anybody through you wake upafter the surgery and you feel
like yourself, like it's a gamechanger.
(04:47):
If that's the deal, okay.
So there's that.
There's also a condition calleda perilymphatic fistula, which
is a variation on the same theme.
That sets people up for tons ofhyperacusis.
My point is that both of thoseare hard lesions and they
require some pretty thoroughdiagnosis and they're extremely
commonly missed, like we see.
Dr. Ayla Wolf (05:10):
I see a bunch of these people all the time and
they've usually seen 20 plusproviders by the time they get
in to see us and then, in termsof getting an actual specific
image of the inner ear to try todiagnose that, can it still get
missed on an MRI?
Dr. Glen Zielinski (05:22):
MRI?
Absolutely, because the MRI isthe wrong image.
So what you need to do is ahigh resolution temporal bone CT
that also looks at the internalauditory canal, and that's an
image where they do these tinyfine 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 onthese things, you'll literally
(05:46):
see here's the hoop, here's thisbone, there's a chunk right
there that's missing.
Dr. Ayla Wolf (05:49):
Got it.
That's another reason why,again, some of my patients
they're like well, I got aspecific MRI for my ear and it
was normal, and yet they'restill having all these symptoms
that are just, yeah, kind ofsmells like SCD.
Dr. Glen Zielinski (06:07):
Yeah, scd is really is really really common.
Right, and again that when Iwhen I say really common, it's
really common in my practice,because you know my practice,
kind of self-flex for the stuffthat nobody else gets to fix
right but um, but the thingabout that, I mean it's still
considered to be a rarecondition but if you're somebody
that, like, fell and hit theback of your head on concrete or
something like that andeverything goes south, or fell
on the ice and stuff, if yousmash the back of your head,
(06:31):
it's really really common thatyou wind up with stuff like SCD
and hard vestibular lesions thatpeople miss.
That's just not that rare.
As far as hyperacusis goes, theother things that have a
tendency to mess with people, Imean there's, there's a little
muscle that basically tightensyour tympanic membrane in
response to loud noises andthat's brain stem driven.
(06:54):
And if that, if there's somebrain stem pathways that aren't
working effectively, then it canbe really difficult for you to
contract that muscle and, as aconsequence, you know like you
just can't attenuate loud sounds.
Uh, that you can figure out bylooking at different cranial
nerve functions and see exactlywhere that issue is and find
ways to directly simulate that.
I find that that kind of stuff,when we see it, responds really
(07:15):
well to specific types ofelectrical stimulation.
Um, they're one of the thingsthat we see really commonly and
this isn't just abouthyperacusis, but if you're light
sensitive and sound sensitiveand visually motion sensitive
and you've got tons of anxietyand things like that, and if
you're like somebody that youknow you drive and you stop at a
(07:35):
light and you feel like you'restill moving forward and that
kind of thing, it's reallycommon that what's happening is
that you've got one side of yourmidbrain, the top part of your
brainstem, firing way too highbecause you can't inhibit it
correctly any longer and thatcan be from a midbrain lesion or
that can be from descendingbasal ganglia problem.
Um, and the diagnostics on that.
(07:56):
You put somebody in the dark oninfrared, you have them look up
and you'll see one eye come inand get stuck or go into like
convergence, retraction tostagnance or something like that
.
That area of the midbrainthat's wound up in those
situations is the primary relayfor light and sound and it's the
primary output for stress.
And people that have that issuethey're usually having tons of
(08:19):
anxiety and they can't sleep andyou know things like vergence.
They always feel like if youlook up, you feel like you're
moving forward and all kinds ofstuff that just doesn't seem to
make any sense until you can tieit all together into one little
nut and go.
That's the area of the brainthat needs the help and there's
great ways to fix that.
I mean, we fix that stuff allday long, but it's.
It's challenging to figure out,but once you see it and you
(08:42):
know what to do about it, youcan usually make that go away
pretty quickly I love it, do youfind?
Dr. Ayla Wolf (08:46):
so?
Okay, going back to thevibration on the knee, are you
finding like 100 of the timewhen someone says, yes, I can
hear that.
That then when you send themoff for the proper imaging that
that's what they're seeing isthe scd.
Dr. Glen Zielinski (09:02):
I would say 80% of the time that's what we
see, and I think that 20% isbased on people not quite
understanding the instructionson that test.
Sure, and the thing is, if youdo 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 ifyou have to explain that to
(09:24):
somebody like five times, you'relike no, no, no, no.
I just, I know you feel it, Ijust want to know if you hear it
right.
By the time that's happenedyou've changed their system
enough that it's probably notthe most reliable test.
But again, people with SCD, youknow you should be able to go
okay, you take your tuning fork,you tap it.
Now you don't hit it hard, youdon't want to give them the big,
loud noise, right, but you, youtap it, get it vibrating, put
(09:47):
it in your hand.
You should be able to tell thatyou can feel the vibration
there.
Put it on one side, they don'thear it.
Put it on the other side, theyhear it.
And the side that they'rehearing it is the side of the
increased bone conduction thatcomes from having a resonant
cavity next to your hearingapparatus.
Yeah, yeah, got it and it's,it's very reliable okay, I'm
(10:10):
gonna start using that.
Dr. Ayla Wolf (10:11):
I I've got somebody coming in next week
that I need to do this onimmediately.
Dr. Glen Zielinski (10:15):
Yeah, cool uh, you'll usually find that
with that same person.
If you do like you know, like aweber and a renee test, if you
stick a tuning fork on thatmastoid, they're gonna hate it,
they're gonna run for the exitand 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 knowyeah, now there aren't very many
surgeons that actually performthat surgery are there uh, there
, let's put it this way therearen'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 atleast you know I mean, they'll
be aware of the procedure.
But this is the kind of thingwhere 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 aninteresting name for a surgeon,
(11:12):
right?
But, uh, he was in Portland,he'd done more STD surgeries
than anybody on the planet, andthen 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.
So, I mean, I have lots ofpatients where, if it's
something complicated, likesomething seriously complicated,
I'll still send him out tojersey and have them go and see,
(11:36):
see ashley, and he'll put themback together and that's a
challenge, because they can'tfly, because altitude messes
them up right and after thesurgery they can't fly for like
basically a year, because youneed to make sure that that the
bone patch that they're puttingin has an opportunity to fully
stabilize, and stuff like that.
So they're like taking thetrain to get there and stuff
(11:58):
like that, but anyway, but theycome back and they're in
different humans yeah, wow.
Dr. Ayla Wolf (12:04):
and then tell me a little bit about your clinic,
because when I I got to shadowyou, you were at your other
clinic and since then you havebought this building and
completely remodeled it in a waythat you were really thinking
about your patients and theirexperience as you created this
amazing place.
You've won two differentarchitectural awards the Best
(12:27):
Small Healthcare Facility Awardof 2020 by the International
Interior Design Association,which is the highest award
somebody can get, as well as theHonor Award of 2022 from the
American Institute ofArchitecture.
So tell me all about your spaceand the thought that went into
it.
Dr. Glen Zielinski (12:45):
So tell me all about your space and the
thought that went into it.
The thought that I ended withwas what do you mean?
It's going to be a millionbucks, okay, so here's the deal.
So I bought this building atthe end of 2016.
And actually on my birthday in2016, I gave myself a
multi-million dollar birthdaypresent.
Like actually on my birthday in2016, I gave myself a
(13:09):
multimillion dollar birthdaypresent.
And then, yeah, so my wife'sbeen 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 theend of 2018 because we gutted
this place and we ripped itapart.
And when I first started and thedesign process, I found these
(13:31):
architects that were just, youknow, the coolest architects I
could find.
They'd done like some of myfavorite wineries and they did a
spectacular job on a friend'shouse and stuff like that.
So I hooked up with them andtold them what I wanted, told
them what I'm you know, theplace was about brain injury and
stuff like that and they'relike, okay, we'll get back to
you.
And then they ghosted me and Ididn't hear from them for like
three months.
And I was just about to sign acontract with somebody else when
(13:57):
they called me up and they'relike okay, we got it, we need a
meeting.
And they came in and theypresented this amazing thing to
me and I was like that's mindblowing.
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 offand they're like you don't
understand.
We spent the last three monthscombing the literature to figure
out exactly what it means tohave a brain injury and, for
example, we figured out thatthere's this one Pantone shade
(14:19):
of forest green that in theliterature has been shown to be
the most calming for people thathave got photophobia.
And then we figured out thatthe literature says that the
auditory frequency that tends tobe the most aggravating for
people with hyperacusis is like2.4 kilohertz or something like
that.
And then we found this companyin Germany that makes this felt
(14:41):
that we can get made in thatcolor that absorbs at 2.38.
And I'm like wrap the clinic init.
And they're like well, that'llbe half a million bucks.
And I'm like wrap half theclinic in it, you know, et
cetera, et cetera.
So my, my building used to be aStarbucks, which was interesting
because it smelled like coffeefor a year, but, um, but it has
this huge atrium with, like youknow, a 40 foot ceilings or 45
(15:05):
foot ceilings and windows up topand all this stuff and somebody
with vertigo I mean, that's thewaiting room right Somebody
with vertigo sitting in thatspace.
They would just melt down,they'd have a panic attack,
right?
So what these guys did was theybuilt like this virtual reality
model of the space and thenthey found this way to create
vertigo simulating software andthey put the software on and
(15:28):
then they walked through themodel and they found every space
in the building that wasmessing with them and giving
them vertigo, and then they justplayed with the shapes until it
was gone, right?
So if you walk in and you sitin this atrium, you'll see like
there's this whacked out shapeswith all these bizarre floating
(15:49):
light towers that they built.
So I've got like this big lightthing 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 andeverything else, but then
there's this weird, bizarreshape that I can't even describe
, and it's a light cloud and Timthe architect was just sitting
there going like bending ituntil until it made him stop
(16:11):
wanting to puke it there, goinglike bending it until until it
made him stop wanting to puke.
Okay, that's the shape.
And then it was like let's dothat with a coffee table and
let's let's put plants in thecoffee, and and anyway.
So they did that through thewhole space.
Um, and, and it's amazing, Imean like people walk in to my
clinic like the thing about thisspace is that it's actually
it's a therapy.
The space itself is a therapy,all right, and and it's
(16:35):
spectacular in that regard, um,people walk in.
You can just see as soon asthey walk in for the very first
time, because they're in likemeltdown mode, they're in full,
you know sensory flooding,overwhelm mode and everything
else, and they walk in and theyclose the front door behind them
and they look around and thenyou can just see people have
their first deep breath sincetheir, their injury, you know,
(16:57):
they just they just like chilland the space is just incredibly
therapeutic, you know wow I Idid.
Dr. Ayla Wolf (17:04):
I didn't know that was going to be such a cool
story.
I thought you were just goingto say oh yeah, we, you know,
dim the lights a little bit.
That turned into a whole otherstory.
Dr. Glen Zielinski (17:13):
Oh yeah, no, it's great.
You need to come and hang outand check it out.
Dr. Ayla Wolf (17:19):
I want to you also have a big pond in the back
too, right?
Dr. Glen Zielinski (17:23):
Yeah, so I own a lake, which is sort of
weird.
I never expected to be able tosay that.
So we have our big waiting roomup at the front.
That's where all the pseudochaos is, and actually I think
the biggest compliment I cangive the architects and the
designers is that it's extremelycommon that we'll just be
(17:45):
totally slammed, completelyrunning our asses off 45 minutes
an hour behind the staff isjust in battle mode, and then
I'll get into a room with apatient.
They'll be like oh, you guysaren't very busy today, are you?
Dr. Ayla Wolf (17:59):
Wow.
Dr. Glen Zielinski (18:00):
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 builta specific lounge just for our
intensive patients, right, andthat faces out onto the lake.
So it's like this crazy idyllicspace, you know, and everybody
goes and hangs out outside.
(18:21):
We had a goose named Gustav whowas a Lake-as-we-go legend.
He was the Chinese goose.
He'd been living in the pond orthe lake or whatever you want
to call it, forever.
I mean, they're only supposedto live about 12 or 14 years,
something like that.
He was there for like 23 years.
Everybody knew gustav and um,then gustav unfortunately got
(18:45):
taken down by a coyote last yearand everybody in town lost it,
you know.
I mean he was getting likewritten up in the local papers
and stuff like that, and I waslike, well, I can't let that
stand.
So I had to get another goose.
And then somebody told me youknow, gustav had a mate for
years and they just followedaround.
(19:06):
So then I was like, okay, Iguess I gotta get gustav a mate.
And then I was on this websitelooking up how I, you know, like
promote shipping for keys and Isaw these things called runner
ducks.
I'd never seen a runner duck inmy life.
They're the.
They're the most ridiculous,hysterical looking things you'll
ever see in your life.
They're like little t-rexesthat run like this, oh my gosh.
So next thing you know, nextthing you know, I have like
(19:29):
eight runner ducks right and andunfortunately somebody pointed
out to me if they're not wild,you can't just cut them loose
because they're not waterproofyet you have to keep them
indoors for six weeks.
So I had eight ducks and babygeese in my garage and I would
(19:50):
never advocate anybody do thatbecause, oh, but anyway.
So ultimately, yeah, ultimately, I pawned them off on a staff
member and they were able toraise them for the last couple
of weeks.
But now?
So the point is that they alllive up in the, in the, in the
pond, and I'm using them as, uh,a great.
I almost use themdiagnostically, because my
(20:11):
primary exam room, where I meetall my new patients, is at the
back of the clinic.
So there's like here's theintensive lounge, there's this
little hallway, then here's myspace, and there's steps right
here going out into the pond,and they've figured out that
anytime they hear somebodythat's not I don't know if it's
about hearing, you know, maybethey just do it all the time
anyway because they figured outthat anytime they hear somebody
(20:33):
I don't know if it's abouthearing, maybe they just do it
all the time anyway because theyfigured out that it's going to
work for them.
But Gustav and his wife, gustavJr and his wife and now their
kid, they have a baby they sitout there and they just honk at
us nonstop.
So if I'm in with a new patientI can immediately be able to
tell if they can inhibit,because there's Gustav like
(20:54):
screaming at us, going like Iwant it you get out here and
feed me now, right?
So yeah, they live pretty fat,happy lives and by the time
we're done and you know you canpick them up and stuff like that
, they, they love people.
So by the time anybody finishesan intensive with us, they're
usually taking pictures with thegeese and the ducks on their
(21:15):
laps and stuff like that.
Dr. Ayla Wolf (21:17):
Oh, that's awesome.
Dr. Glen Zielinski (21:19):
Anyway.
So there's that.
Dr. Ayla Wolf (21:20):
Wow, what an incredible experience that
you've built.
Dr. Glen Zielinski (21:24):
Yeah, well, it's been uh, it's been a long
time coming, but it's a prettyfantastic space.
And, again, you know, we haveevery conceivable form of
therapy.
We've got two rotational chairs.
We have, you know, like a fullphysical 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 navyseals.
(21:45):
So we built like this big rehabspace for when I get to work
with, you know, special forcesguys and stuff like that and um,
that's proven to be a lot offun, because now when I talked
about our last gig in thattherapeutic process, integrating
stuff, that's where we justhave this massive space to just
with, like you know, 20 footceilings, to just go and do
(22:06):
whatever the heck we want withpeople, and that involves all
kinds of things that are superentertaining for us and it takes
a little bit too long todescribe, so we'll punt on that.
Dr. Ayla Wolf (22:19):
All right.
Well, if you need an assistantnext time they come through, I'm
there.
Dr. Glen Zielinski (22:23):
Yeah, fair enough.
Dr. Ayla Wolf (22:27):
So you know what happens when you and I get
together, though.
Right Well, you get kicked inthe head, yeah.
Dr. Glen Zielinski (22:32):
Yeah, yeah, yeah, yeah, that's's it.
So I don't know how many ofyour listeners or viewers know
this, but it was prettyaccomplished martial artist.
I so am I, and anytime we windup in town together I get to
discover the glory of herfadeaway head kick.
Dr. Ayla Wolf (22:48):
It's spectacular I'm old and stiff now.
I don't think my, I don't thinkmy leg's going to reach anymore
, sorry.
Dr. Glen Zielinski (22:57):
Still, dude, it's spectacular.
Nobody's landed that on me inyears, other than you.
Dr. Ayla Wolf (23:01):
Oh well.
Dr. Glen Zielinski (23:02):
So anyway, there's that.
Dr. Ayla Wolf (23:06):
Awesome.
Well, I would love to come seeyour new space.
Dr. Glen Zielinski (23:09):
Fantastic.
Dr. Ayla Wolf (23:12):
All right.
Well, how can people find you?
Dr. Glen Zielinski (23:15):
uh, well, uh , so we're in lake as we go
argon, which is basically, youknow, suburban portland.
Um, our website is northwestfunctional neurologycom.
Um, and, yeah, most people justreach out to us through there.
The email is like info atnorthwestfunctionalneurologycom
(23:35):
Website, youtube channel, I meanall that kind of stuff.
That's usually where peoplefind us.
Dr. Ayla Wolf (23:39):
Awesome.
Well, thanks so much for yourtime.
Enjoy your soiree tonight.
Dr. Glen Zielinski (23:45):
You have a great weekend.
Dr. Ayla Wolf (23:46):
Thank you, thank you.
Dr. Glen Zielinski (23:47):
All right, have a great day you too.
Dr. Ayla Wolf (23:53):
Medical Disclaimer.
Have a great day, you, too.
Medical disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional health careservices, including the giving
of medical advice.
No doctor patient relationshipis formed.
The use of this information andmaterials included is at the
(24:13):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
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A link to our full medicaldisclaimer is available in the
notes.
But if you're somebody that like fell
and hit the back of your head onconcrete or something like that
and everything goes south, orfell on the ice and stuff like I
mean, if you smash the back ofyour head, it's really, really
common that you wind up withstuff like STD and hard
vestibular lesions that peoplemiss.
That's just not that rare.
Dr. Ayla Wolf (00:19):
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolf and I will behosting today's episode, where
we help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go-toresource for actionable
information, whether you'redealing with a recent concussion
(00:40):
, struggling withpost-concussion syndrome or just
feeling stuck in your healingprocess.
In each episode we dive deepinto the symptoms, testing,
treatments and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
(01:02):
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
you build a better life afterimpact.
What other things are you doingfor hyperacusis, specifically
(01:23):
Because I know that plagues alot of people that have had
concussions?
Dr. Glen Zielinski (01:28):
Well, okay, so when you look at what happens
with hyperacusis, there are afew situations that I actually
see quite a bit that peoplemissed, and one of them is
something called superior canaldehiscence.
And the idea of SCD is that.
So your vestibular system hassemicircular canals and otoliths
(01:54):
right, and the semicircularcanals are these little
fluid-filled tubes, these littlehoops with hair cells and fluid
, and the idea is that when youturn your head quickly, it takes
a second for the fluid to startto move.
So that bends hair cells, tellsyour brainstem hey, my head's
turning this way so it can fireappropriate responses.
There's three of those on eachside, and the anterior canals,
the superior canals.
(02:15):
The bone at the top of thosecanals is really thin, like it's
.
You're lucky if it's amillimeter thick at the best of
times.
And, and the thing is, theseare pressure-sensitive systems
so they need to be encased inbone 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 thatchunk of bone together and it's
(02:38):
just a pile of soft tissue, it'sjust thick connective tissue.
Now the thing is, if you stubyour head, like if you smash
your mastoid bone or somethinglike that, you can blow the top
off that bone or you can popthose membranes and create a
little fistula, all right, andnow what you have is a resonant
cavity, and that resonant cavitycan make everything loud.
And generally, when people havesomething like this, they don't
(03:01):
just hear the world loud, theyalso hear like their voice loud
inside their head and they getthings like pulsatile tinnitus,
they can hear their heartbeatsand they look like they've had
the world's worst concussionsbecause they just can't respond
to any sensory stimulation.
And there's a really simpletest to figure that out.
And and they're also like superpressure sensitive and altitude
sensitive and stuff like that.
(03:21):
And the test is you just take atuning fork and you tap it and
you get it vibrating, but haveit vibrating just just slightly
and then pop it on their kneecapand ask if they can hear it,
because they shouldn't be ableto hear that, they just only be
able to feel it.
But if you have a resonantcavity that's developed around
there, then all, then they'regoing to hear that vibration.
(03:42):
They're going to hear the tone,then all, then they're going to
hear that vibration.
They're going to hear the toneright now.
The thing about scd that's asurgical fix.
All right, you can do a bunchof stuff to try to stabilize all
the consequences of that, butunfortunately those are, that's
just.
That's a surgical issue.
Um, there was a surgeon inportland back in the day who was
one of the people thatdiscovered scd and did more SCD
(04:05):
surgeries than anybody on theplanet and everything else.
And then when he retired, theguy that took over his practice
was the top SCD surgeon in theworld.
He's out of records now, but heused to send me all of his
patients for rehab and viceversa, and he was telling me
that SCD has an extremely highmortality rate and the mortality
(04:26):
rate is just from suicide,because people just can't stand
all the input and they can'tstand the sound and it's just
totally crazy making for themand stuff like that.
Right, and the reason I'mharping on this diagnosis is
that if this is what you'redealing with even though skull
base surgery sounds like aterrible thing for it to put
anybody through you wake upafter the surgery and you feel
like yourself, like it's a gamechanger.
(04:47):
If that's the deal, okay.
So there's that.
There's also a condition calleda perilymphatic fistula, which
is a variation on the same theme.
That sets people up for tons ofhyperacusis.
My point is that both of thoseare hard lesions and they
require some pretty thoroughdiagnosis and they're extremely
commonly missed, like we see.
Dr. Ayla Wolf (05:10):
I see a bunch of these people all the time and
they've usually seen 20 plusproviders by the time they get
in to see us and then, in termsof getting an actual specific
image of the inner ear to try todiagnose that, can it still get
missed on an MRI?
Dr. Glen Zielinski (05:22):
MRI?
Absolutely, because the MRI isthe wrong image.
So what you need to do is ahigh resolution temporal bone CT
that also looks at the internalauditory canal, and that's an
image where they do these tinyfine 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 onthese things, you'll literally
(05:46):
see here's the hoop, here's thisbone, there's a chunk right
there that's missing.
Dr. Ayla Wolf (05:49):
Got it.
That's another reason why,again, some of my patients
they're like well, I got aspecific MRI for my ear and it
was normal, and yet they'restill having all these symptoms
that are just, yeah, kind ofsmells like SCD.
Dr. Glen Zielinski (06:07):
Yeah, scd is really is really really common.
Right, and again that when Iwhen I say really common, it's
really common in my practice,because you know my practice,
kind of self-flex for the stuffthat nobody else gets to fix
right but um, but the thingabout that, I mean it's still
considered to be a rarecondition but if you're somebody
that, like, fell and hit theback of your head on concrete or
something like that andeverything goes south, or fell
on the ice and stuff, if yousmash the back of your head,
(06:31):
it's really really common thatyou wind up with stuff like SCD
and hard vestibular lesions thatpeople miss.
That's just not that rare.
As far as hyperacusis goes, theother things that have a
tendency to mess with people, Imean there's, there's a little
muscle that basically tightensyour tympanic membrane in
response to loud noises andthat's brain stem driven.
(06:54):
And if that, if there's somebrain stem pathways that aren't
working effectively, then it canbe really difficult for you to
contract that muscle and, as aconsequence, you know like you
just can't attenuate loud sounds.
Uh, that you can figure out bylooking at different cranial
nerve functions and see exactlywhere that issue is and find
ways to directly simulate that.
I find that that kind of stuff,when we see it, responds really
(07:15):
well to specific types ofelectrical stimulation.
Um, they're one of the thingsthat we see really commonly and
this isn't just abouthyperacusis, but if you're light
sensitive and sound sensitiveand visually motion sensitive
and you've got tons of anxietyand things like that, and if
you're like somebody that youknow you drive and you stop at a
(07:35):
light and you feel like you'restill moving forward and that
kind of thing, it's reallycommon that what's happening is
that you've got one side of yourmidbrain, the top part of your
brainstem, firing way too highbecause you can't inhibit it
correctly any longer and thatcan be from a midbrain lesion or
that can be from descendingbasal ganglia problem.
Um, and the diagnostics on that.
(07:56):
You put somebody in the dark oninfrared, you have them look up
and you'll see one eye come inand get stuck or go into like
convergence, retraction tostagnance or something like that
.
That area of the midbrainthat's wound up in those
situations is the primary relayfor light and sound and it's the
primary output for stress.
And people that have that issuethey're usually having tons of
(08:19):
anxiety and they can't sleep andyou know things like vergence.
They always feel like if youlook up, you feel like you're
moving forward and all kinds ofstuff that just doesn't seem to
make any sense until you can tieit all together into one little
nut and go.
That's the area of the brainthat needs the help and there's
great ways to fix that.
I mean, we fix that stuff allday long, but it's.
It's challenging to figure out,but once you see it and you
(08:42):
know what to do about it, youcan usually make that go away
pretty quickly I love it, do youfind?
Dr. Ayla Wolf (08:46):
so?
Okay, going back to thevibration on the knee, are you
finding like 100 of the timewhen someone says, yes, I can
hear that.
That then when you send themoff for the proper imaging that
that's what they're seeing isthe scd.
Dr. Glen Zielinski (09:02):
I would say 80% of the time that's what we
see, and I think that 20% isbased on people not quite
understanding the instructionson that test.
Sure, and the thing is, if youdo 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 ifyou have to explain that to
(09:24):
somebody like five times, you'relike no, no, no, no.
I just, I know you feel it, Ijust want to know if you hear it
right.
By the time that's happenedyou've changed their system
enough that it's probably notthe most reliable test.
But again, people with SCD, youknow you should be able to go
okay, you take your tuning fork,you tap it.
Now you don't hit it hard, youdon't want to give them the big,
loud noise, right, but you, youtap it, get it vibrating, put
(09:47):
it in your hand.
You should be able to tell thatyou can feel the vibration
there.
Put it on one side, they don'thear it.
Put it on the other side, theyhear it.
And the side that they'rehearing it is the side of the
increased bone conduction thatcomes from having a resonant
cavity next to your hearingapparatus.
Yeah, yeah, got it and it's,it's very reliable okay, I'm
(10:10):
gonna start using that.
Dr. Ayla Wolf (10:11):
I I've got somebody coming in next week
that I need to do this onimmediately.
Dr. Glen Zielinski (10:15):
Yeah, cool uh, you'll usually find that
with that same person.
If you do like you know, like aweber and a renee test, if you
stick a tuning fork on thatmastoid, they're gonna hate it,
they're gonna run for the exitand 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 knowyeah, now there aren't very many
surgeons that actually performthat surgery are there uh, there
, let's put it this way therearen'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 atleast you know I mean, they'll
be aware of the procedure.
But this is the kind of thingwhere 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 aninteresting name for a surgeon,
(11:12):
right?
But, uh, he was in Portland,he'd done more STD surgeries
than anybody on the planet, andthen 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.
So, I mean, I have lots ofpatients where, if it's
something complicated, likesomething seriously complicated,
I'll still send him out tojersey and have them go and see,
(11:36):
see ashley, and he'll put themback together and that's a
challenge, because they can'tfly, because altitude messes
them up right and after thesurgery they can't fly for like
basically a year, because youneed to make sure that that the
bone patch that they're puttingin has an opportunity to fully
stabilize, and stuff like that.
So they're like taking thetrain to get there and stuff
(11:58):
like that, but anyway, but theycome back and they're in
different humans yeah, wow.
Dr. Ayla Wolf (12:04):
and then tell me a little bit about your clinic,
because when I I got to shadowyou, you were at your other
clinic and since then you havebought this building and
completely remodeled it in a waythat you were really thinking
about your patients and theirexperience as you created this
amazing place.
You've won two differentarchitectural awards the Best
(12:27):
Small Healthcare Facility Awardof 2020 by the International
Interior Design Association,which is the highest award
somebody can get, as well as theHonor Award of 2022 from the
American Institute ofArchitecture.
So tell me all about your spaceand the thought that went into
it.
Dr. Glen Zielinski (12:45):
So tell me all about your space and the
thought that went into it.
The thought that I ended withwas what do you mean?
It's going to be a millionbucks, okay, so here's the deal.
So I bought this building atthe end of 2016.
And actually on my birthday in2016, I gave myself a
multi-million dollar birthdaypresent.
Like actually on my birthday in2016, I gave myself a
(13:09):
multimillion dollar birthdaypresent.
And then, yeah, so my wife'sbeen 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 theend of 2018 because we gutted
this place and we ripped itapart.
And when I first started and thedesign process, I found these
(13:31):
architects that were just, youknow, the coolest architects I
could find.
They'd done like some of myfavorite wineries and they did a
spectacular job on a friend'shouse and stuff like that.
So I hooked up with them andtold them what I wanted, told
them what I'm you know, theplace was about brain injury and
stuff like that and they'relike, okay, we'll get back to
you.
And then they ghosted me and Ididn't hear from them for like
three months.
And I was just about to sign acontract with somebody else when
(13:57):
they called me up and they'relike okay, we got it, we need a
meeting.
And they came in and theypresented this amazing thing to
me and I was like that's mindblowing.
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 offand they're like you don't
understand.
We spent the last three monthscombing the literature to figure
out exactly what it means tohave a brain injury and, for
example, we figured out thatthere's this one Pantone shade
(14:19):
of forest green that in theliterature has been shown to be
the most calming for people thathave got photophobia.
And then we figured out thatthe literature says that the
auditory frequency that tends tobe the most aggravating for
people with hyperacusis is like2.4 kilohertz or something like
that.
And then we found this companyin Germany that makes this felt
(14:41):
that we can get made in thatcolor that absorbs at 2.38.
And I'm like wrap the clinic init.
And they're like well, that'llbe half a million bucks.
And I'm like wrap half theclinic in it, you know, et
cetera, et cetera.
So my, my building used to be aStarbucks, which was interesting
because it smelled like coffeefor a year, but, um, but it has
this huge atrium with, like youknow, a 40 foot ceilings or 45
(15:05):
foot ceilings and windows up topand all this stuff and somebody
with vertigo I mean, that's thewaiting room right Somebody
with vertigo sitting in thatspace.
They would just melt down,they'd have a panic attack,
right?
So what these guys did was theybuilt like this virtual reality
model of the space and thenthey found this way to create
vertigo simulating software andthey put the software on and
(15:28):
then they walked through themodel and they found every space
in the building that wasmessing with them and giving
them vertigo, and then they justplayed with the shapes until it
was gone, right?
So if you walk in and you sitin this atrium, you'll see like
there's this whacked out shapeswith all these bizarre floating
(15:49):
light towers that they built.
So I've got like this big lightthing 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 andeverything else, but then
there's this weird, bizarreshape that I can't even describe
, and it's a light cloud and Timthe architect was just sitting
there going like bending ituntil until it made him stop
(16:11):
wanting to puke it there, goinglike bending it until until it
made him stop wanting to puke.
Okay, that's the shape.
And then it was like let's dothat with a coffee table and
let's let's put plants in thecoffee, and and anyway.
So they did that through thewhole space.
Um, and, and it's amazing, Imean like people walk in to my
clinic like the thing about thisspace is that it's actually
it's a therapy.
The space itself is a therapy,all right, and and it's
(16:35):
spectacular in that regard, um,people walk in.
You can just see as soon asthey walk in for the very first
time, because they're in likemeltdown mode, they're in full,
you know sensory flooding,overwhelm mode and everything
else, and they walk in and theyclose the front door behind them
and they look around and thenyou can just see people have
their first deep breath sincetheir, their injury, you know,
(16:57):
they just they just like chilland the space is just incredibly
therapeutic, you know wow I Idid.
Dr. Ayla Wolf (17:04):
I didn't know that was going to be such a cool
story.
I thought you were just goingto say oh yeah, we, you know,
dim the lights a little bit.
That turned into a whole otherstory.
Dr. Glen Zielinski (17:13):
Oh yeah, no, it's great.
You need to come and hang outand check it out.
Dr. Ayla Wolf (17:19):
I want to you also have a big pond in the back
too, right?
Dr. Glen Zielinski (17:23):
Yeah, so I own a lake, which is sort of
weird.
I never expected to be able tosay that.
So we have our big waiting roomup at the front.
That's where all the pseudochaos is, and actually I think
the biggest compliment I cangive the architects and the
designers is that it's extremelycommon that we'll just be
(17:45):
totally slammed, completelyrunning our asses off 45 minutes
an hour behind the staff isjust in battle mode, and then
I'll get into a room with apatient.
They'll be like oh, you guysaren't very busy today, are you?
Dr. Ayla Wolf (17:59):
Wow.
Dr. Glen Zielinski (18:00):
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 builta specific lounge just for our
intensive patients, right, andthat faces out onto the lake.
So it's like this crazy idyllicspace, you know, and everybody
goes and hangs out outside.
(18:21):
We had a goose named Gustav whowas a Lake-as-we-go legend.
He was the Chinese goose.
He'd been living in the pond orthe lake or whatever you want
to call it, forever.
I mean, they're only supposedto live about 12 or 14 years,
something like that.
He was there for like 23 years.
Everybody knew gustav and um,then gustav unfortunately got
(18:45):
taken down by a coyote last yearand everybody in town lost it,
you know.
I mean he was getting likewritten up in the local papers
and stuff like that, and I waslike, well, I can't let that
stand.
So I had to get another goose.
And then somebody told me youknow, gustav had a mate for
years and they just followedaround.
(19:06):
So then I was like, okay, Iguess I gotta get gustav a mate.
And then I was on this websitelooking up how I, you know, like
promote shipping for keys and Isaw these things called runner
ducks.
I'd never seen a runner duck inmy life.
They're the.
They're the most ridiculous,hysterical looking things you'll
ever see in your life.
They're like little t-rexesthat run like this, oh my gosh.
So next thing you know, nextthing you know, I have like
(19:29):
eight runner ducks right and andunfortunately somebody pointed
out to me if they're not wild,you can't just cut them loose
because they're not waterproofyet you have to keep them
indoors for six weeks.
So I had eight ducks and babygeese in my garage and I would
(19:50):
never advocate anybody do thatbecause, oh, but anyway.
So ultimately, yeah, ultimately, I pawned them off on a staff
member and they were able toraise them for the last couple
of weeks.
But now?
So the point is that they alllive up in the, in the, in the
pond, and I'm using them as, uh,a great.
I almost use themdiagnostically, because my
(20:11):
primary exam room, where I meetall my new patients, is at the
back of the clinic.
So there's like here's theintensive lounge, there's this
little hallway, then here's myspace, and there's steps right
here going out into the pond,and they've figured out that
anytime they hear somebodythat's not I don't know if it's
about hearing, you know, maybethey just do it all the time
anyway because they figured outthat anytime they hear somebody
(20:33):
I don't know if it's abouthearing, maybe they just do it
all the time anyway because theyfigured out that it's going to
work for them.
But Gustav and his wife, gustavJr and his wife and now their
kid, they have a baby they sitout there and they just honk at
us nonstop.
So if I'm in with a new patientI can immediately be able to
tell if they can inhibit,because there's Gustav like
(20:54):
screaming at us, going like Iwant it you get out here and
feed me now, right?
So yeah, they live pretty fat,happy lives and by the time
we're done and you know you canpick them up and stuff like that
, they, they love people.
So by the time anybody finishesan intensive with us, they're
usually taking pictures with thegeese and the ducks on their
(21:15):
laps and stuff like that.
Dr. Ayla Wolf (21:17):
Oh, that's awesome.
Dr. Glen Zielinski (21:19):
Anyway.
So there's that.
Dr. Ayla Wolf (21:20):
Wow, what an incredible experience that
you've built.
Dr. Glen Zielinski (21:24):
Yeah, well, it's been uh, it's been a long
time coming, but it's a prettyfantastic space.
And, again, you know, we haveevery conceivable form of
therapy.
We've got two rotational chairs.
We have, you know, like a fullphysical 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 navyseals.
(21:45):
So we built like this big rehabspace for when I get to work
with, you know, special forcesguys and stuff like that and um,
that's proven to be a lot offun, because now when I talked
about our last gig in thattherapeutic process, integrating
stuff, that's where we justhave this massive space to just
with, like you know, 20 footceilings, to just go and do
(22:06):
whatever the heck we want withpeople, and that involves all
kinds of things that are superentertaining for us and it takes
a little bit too long todescribe, so we'll punt on that.
Dr. Ayla Wolf (22:19):
All right.
Well, if you need an assistantnext time they come through, I'm
there.
Dr. Glen Zielinski (22:23):
Yeah, fair enough.
Dr. Ayla Wolf (22:27):
So you know what happens when you and I get
together, though.
Right Well, you get kicked inthe head, yeah.
Dr. Glen Zielinski (22:32):
Yeah, yeah, yeah, yeah, that's's it.
So I don't know how many ofyour listeners or viewers know
this, but it was prettyaccomplished martial artist.
I so am I, and anytime we windup in town together I get to
discover the glory of herfadeaway head kick.
Dr. Ayla Wolf (22:48):
It's spectacular I'm old and stiff now.
I don't think my, I don't thinkmy leg's going to reach anymore
, sorry.
Dr. Glen Zielinski (22:57):
Still, dude, it's spectacular.
Nobody's landed that on me inyears, other than you.
Dr. Ayla Wolf (23:01):
Oh well.
Dr. Glen Zielinski (23:02):
So anyway, there's that.
Dr. Ayla Wolf (23:06):
Awesome.
Well, I would love to come seeyour new space.
Dr. Glen Zielinski (23:09):
Fantastic.
Dr. Ayla Wolf (23:12):
All right.
Well, how can people find you?
Dr. Glen Zielinski (23:15):
uh, well, uh , so we're in lake as we go
argon, which is basically, youknow, suburban portland.
Um, our website is northwestfunctional neurologycom.
Um, and, yeah, most people justreach out to us through there.
The email is like info atnorthwestfunctionalneurologycom
(23:35):
Website, youtube channel, I meanall that kind of stuff.
That's usually where peoplefind us.
Dr. Ayla Wolf (23:39):
Awesome.
Well, thanks so much for yourtime.
Enjoy your soiree tonight.
Dr. Glen Zielinski (23:45):
You have a great weekend.
Dr. Ayla Wolf (23:46):
Thank you, thank you.
Dr. Glen Zielinski (23:47):
All right, have a great day you too.
Dr. Ayla Wolf (23:53):
Medical Disclaimer.
Have a great day, you, too.
Medical disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional health careservices, including the giving
of medical advice.
No doctor patient relationshipis formed.
The use of this information andmaterials included is at the
(24:13):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
medical professional for any andall health related issues.
A link to our full medicaldisclaimer is available in the
notes.
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Gregg Rosenthal and a rotating crew of elite NFL Media co-hosts, including Patrick Claybon, Colleen Wolfe, Steve Wyche, Nick Shook and Jourdan Rodrigue of The Athletic get you caught up daily on all the NFL news and analysis you need to be smarter and funnier than your friends.