BALANCE

Dizziness & Balance

Balance: A biological system that enables us to know where our bodies are in the environment and to maintain a desired position. Normal balance depends on information from the inner ear, other senses (such as sight and touch) and muscle movement.

Our sense of balance is specifically regulated by a complex interaction between the following parts of the nervous system:

1. The inner ears (also called the labyrinth) monitor the directions of motion, such as turning or forward-backward, side-to-side, and up-and-down motions.

2. The eyes observe where the body is in space (i.e., upside down, right side up, etc.) and also the directions of motion.

3. Skin pressure receptors such as those located in the feet and seat sense what part of the body is down and touching the ground.

4. Muscle and joint sensory receptors report what parts of the body are moving.

5. The central nervous system (the brain and spinal cord) processes all the bits of information from the four other systems to make some coordinated sense out of it all.

Balance disorder?

A balance disorder is a condition that makes you feel unsteady or dizzy. If you are standing, sitting, or lying down, you might feel as if you are moving, spinning, or floating. If you are walking, you might suddenly feel as if you are tipping over.

Dizziness, a blanket term used to describe any feeling of unsteadiness, is one of the leading health complaints in the world. Everyone has a dizzy spell now and then, but the term “dizziness” can mean different things to different people. For one person, dizziness might mean a fleeting feeling of faintness, while for another it could be an intense sensation of spinning (vertigo) that lasts a long time.

In the last decade, population-based epidemiologic studies have evidence for the high burden of dizziness or balance problem in the community. Balance problem or Dizziness affects about 15% to over 20% of adults yearly in large population-based studies.

What causes balance disorders?

Balance problem or Dizziness is the result of your brain receiving false signals from the balance system (comprised of the inner ear, eyes and sensory nerves). It senses movement and overcompensates, leading to a spinning sensation, weakness and faintness.

There are many possible causes of balance problems including ear infection low blood pressure, anemia, dehydration, heat-related disorders, endocrine system disorders (e.g., diabetes, thyroid disease), heart conditions, high blood pressure, viral and bacterial infections, head trauma, hyperventilation, neurological disorders and certain medications can lead to dizziness when you stand up too quickly. Problems that affect the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also cause balance disorders. Your risk of having balance problems increases as you get older.

A balance disorder can profoundly affect daily activities and cause psychological and emotional hardship. Unfortunately, many balance disorders start suddenly and with no obvious cause.

What are the symptoms of a balance disorder?

Patients who experience dizziness report a variety of symptoms depending on the exact nature of their balance disorder. These include:

• Lightheadedness.
• Fainting or a floating sensation.
• Falling or feeling as if you are going to fall.
• Staggering when you try to walk.
• Vertigo (the sensation of movement in your surroundings).
• Confusion.
• Disorientation.
• Blurred vision.

Other symptoms might include nausea and vomiting; diarrhoea; changes in heart rate and blood pressure; and fear, anxiety, or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression.

What are some types of balance disorders?

There are more than a dozen different balance disorders. Some of the most common are:

• Benign Paroxysmal Positional Vertigo (BPPV) or positional vertigo: A brief, intense episode of vertigo triggered by a specific change in the position of the head. You might feel as if you're spinning when you bend down to look under something, tilt your head to look up or over your shoulder, or roll over in bed. BPPV occurs when loose otoconia tumble into one of the semi-circular canals and affect how the cupula works. This keeps the cupula from flexing properly, sending incorrect information about your head's position to your brain, and causing vertigo. BPPV can result from a head injury, or can develop just from getting older

• Labyrinthitis: An infection or inflammation of the inner ear that causes dizziness and loss of balance. It is often associated with an upper respiratory infection, such as the flu. Its symptoms include vertigo, temporary hearing loss and tinnitus.

• Meniere’s disease: Episodes of vertigo, hearing loss, tinnitus (a ringing or buzzing in the ear), and a feeling of fullness in the ear. It may be associated with a change in fluid volume within parts of the labyrinth, but the cause or causes are still unknown.

• Vestibular neuronitis: An inflammation of the vestibular nerve that can be caused by a virus, and primarily causes vertigo.

• Perilymph fistula: A leakage of inner ear fluid into the middle ear. It causes unsteadiness that usually increases with activity, along with dizziness and nausea. Perilymph fistula can occur after a head injury, dramatic changes in air pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Some people are born with perilymph fistula.

• Mal de Debarquement syndrome (MdDS): A feeling of continuously rocking, swaying, or bobbing, typically after an ocean cruise or other sea travel, or even after prolonged running on a treadmill. Usually, the symptoms go away within a few hours or days after you reach land or stop using the treadmill. Severe cases, however, can last months or even years, and the cause remains unknown.

How are balance disorders diagnosed?

The vestibular system is complex and responsible for many of the body’s functions. In order to narrow down the exact cause of dizziness. Dizziness is one of the most common complaints, it is a problem that can affect individuals of any age, but it is more of an issue for older adults. It is necessary to administer a variety of tests. These measure eye movements, head movements, hearing and more.

Diagnosis of a balance disorder is difficult. To find out if you have a balance problem, your primary doctor may suggest that you see an Otolaryngologist and an Audiologist. An Otolaryngologist is a physician and surgeon who specializes in diseases and disorders of the ear, nose, neck, and throat. An Audiologist is a clinician who specializes in the function of the hearing and vestibular systems.

Studies indicate vestibular testing is extremely thorough and accurate in identifying inner ear disorders. Vestibular testing is also helpful in determining whether additional diagnostic testing, such as an MRI, is needed. We offer a comprehensive battery of tests that are designed to evaluate a patient's balance system.

• Case History

The word "dizzy" can mean different things to different people. It can mean "lightheadedness," or a "floating" sensation and "spinning" feeling also known as vertigo. As part of our case history, we define the type of problem and then discuss severity, and when, where and how often the problem occurs. We will ask about your individual lifestyle and medical history that will help us to better understand your specific problem.

• Electronystagmography (ENG).

This series of tests measures eye movements via electrodes placed around the eyes. ENG tests usually consist of four parts: evaluation of rapid eye movements, tracking tests to measure eye movements as they follow a visual target, positional test for measuring dizziness in response to different head positions and a caloric test that measures responses to warm and cold water circulating through a tube in the ear canal. Most people reporting dizziness or vertigo will be given ENG tests initially.

• Videonystagmography (VNG).

This is similar to ENG testing, but an infrared video camera attached to a pair of goggles is used in place of electrodes. The same four-part testing process is utilized.

• Vestibular Evoked Myogenic Potential (VEMP).

VEMP testing is used to determine whether the saccule (an inner ear organ) and vestibular nerves are functioning properly. Electrodes are attached to the neck and sounds are transmitted through a pair of headphones. The electrical response of the sternocleidomastoid muscle in the neck is recorded.

• Video Head Impulse testing (vHIT).

vHIT is a clinical test of each semi-circular canal of the inner ear. Ultra-light weight goggles embedded with a camera capable of assessing high rates of eye movements are placed on your head. Your audiologist will perform several head movements and collect data to determine the status of your vestibular system. These tests may be combined with additional hearing or diagnostic tests depending on the results.

How are balance disorders treated?

The first thing an otolaryngologist will do if you have a balance problem is determine if another health condition or a medication is to blame. If so, your doctor will treat the condition, suggest a different medication, or refer you to a specialist if the condition is outside his or her expertise.
If you have BPPV, your otolaryngologist or audiologist might perform a series of simple movements, such as the Epley maneuver, to help dislodge the otoconia from the semi-circular canal. In many cases, one session works; other people need the procedure several times to relieve their dizziness.
If you are diagnosed with Meniere’s disease, your otolaryngologist may recommend that you make some changes to your diet and, if you are a smoker, that you stop smoking. Anti-vertigo or anti-nausea medications may relieve your symptoms, but they can also make you drowsy.
In some severe cases of Meniere’s disease, surgery on the vestibular organs may be needed. Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan.
Talk to your doctor about whether it's safe to drive, and about ways to lower your risk of falling and getting hurt during daily activities, such as when you walk up or down stairs, use the bathroom, or exercise. To reduce your risk of injury from dizziness, avoid walking in the dark. Wear low-heeled shoes or walking shoes outdoors. If necessary, use a cane or walker and modify conditions at your home and workplace, such as adding handrails.

When should I seek help if I think I have a balance disorder?

To help you decide whether to seek medical help for dizziness or balance problems, ask yourself the following questions. If you answer “yes” to any of these questions, talk to your doctor:

• Do I feel unsteady?
• Do I feel as if the room is spinning around me, even for a very brief time?
• Do I feel as if I'm moving when I know I'm sitting or standing still?
• Do I lose my balance and fall?
• Do I feel as if I'm falling?• Do I feel lightheaded or as if I might faint?
• Do I have blurred vision?
• Do I ever feel disoriented—losing my sense of time or location?