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Zarellos to Children's Hospital of Philadelphia,
where Joey was diagnosed with epilepsy and pre-
scribed antiseizure drugs and antidepressants. But
nothing worked.
By the time he was in the fourth grade, Joey was
under the care of a renowned headache specialist.
Debbie Zarello recalls the doctor's recommendation.
"She wanted to put him on pretty serious drugs.
Some were old psychiatric medications with a ton of
side effects," she says. "We just didn't want to go
that route." After spending a year to no avail with
specialists at another hospital, they found Amor
Mehta, MD, an Ocean County neurologist. Under
Dr. Mehta's care, Joey's seizures stopped, but the
migraines and vertigo didn't. Dr. Mehta couldn't get
Joey out of his mind. He was determined to find an
answer. A luncheon that he almost didn't attend led
him to one.
It was there that Dr. Mehta heard Dr. Wackym
talk about the condition known as superior semicir-
cular canal dehiscence--also called third window
syndrome, so named because of an abnormal open-
ing in the bone of the superior canal, immediately
underneath the brain, that creates a third window in the inner
ear. On his way home from the lecture, Dr. Mehta called Debbie
Zarello, told her what he had learned, and gave her Dr.
Wackym's contact information, advising her to consult with him
immediately. That was when the Zarellos finally learned what
was ailing Joey.
Third Window
hen sound comes to the eardrum, it transmits pressure
to the inner ear, which is filled with fluid. Normally,
there are two windows of the inner ear. "The third window
causes an asymmetric stimulation of gravity receptors between
the two inner ears," Dr. Wackym says. "Patients talk about
how loud sounds make them dizzy and sometimes even feel like
the floor is falling out from under them. They can hear internal
sounds, such as their voice resonating. Some can even hear
their eyes and joints moving."
The condition can also produce migraine headaches,
increase light sensitivity, and affect cognitive function as well as
spatial orientation. "Frequently, patients feel detached, feel like
the walls are breathing and floors are moving, as if they're
walking on a trampoline or deck of a boat; they can even have
out-of-body experiences," Dr. Wackym says.
Third window syndrome can also produce anxiety and a
sense of impending doom, which is why it's not uncommon for
these patients to be misdiagnosed with psychiatric problems.
Some have seen as many as 40 doctors before finally getting to
Dr. Wackym.
The causes of third window syndrome are varied. Some peo-
ple can be born with thin bone that, during some traumatic
event such as a car accident or sports injury, forms the third
window. In some cases, the bone wears away over time. There
may be a genetic component to the probability of developing
third window, since Dr. Wackym has encountered five mother-
6 Robert WoodJohnson
oey talks about how much this surgery has
changed his life: "I'm thinking, it's finally over. I'm
looking back at all the headaches and vertigo.
I'm thinking it was so annoying I would have this.
After seven years of having this, I feel amazing.
I feel like a new person."