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Balance Disorders

Dizziness & Balance Disorders

Dizziness & Balance Disorders

Many words are used to describe dizziness. These include disorientation, imbalance, light-headedness and swaying but true vertigo is characterized by a spinning sensation. Vertigo can be accompanied by nausea, vomiting and sweating. For some sufferers, dizziness can last only a few short seconds while others may experience dizziness for much longer periods. Imbalance symptoms can afflict all age groups, but it is most common in older people.

The vestibular system or labyrinth – the balance system – helps us maintain the orientation of our bodies in space and helps us keep our posture and sense of balance. It helps us regulate our movements and focus visually while our bodies are in motion. The balance system uses sensory information from the vestibular organs (balance organs in the inner ear), the visual system and the somatosensory or proprioceptive systems. Sensory nerves associated with our eyes, muscles and joints send their signals to the spinal cord and brain. All these parts work together to help us keep our balance.

The inner ear contains three semicircular canals that are responsible for gathering information about the position and movement of the head and body. Inside the canals is a fluid called endolymph. When you move your head, the endolymph moves, causing information to be sent to the brain about the body’s position.

Common Causes of Dizziness or Unsteadiness Include:

  • Motion sickness
  • Benign Positional Paroxysmal Vertigo (BPPV) (see below)
  • Meniere’s Disease (Endolymphatic Hydrops) (see below)
  • Middle ear fluid
  • Middle ear disease, such as cholesteatoma (see below)
  • Various medications including sedatives or tranquilizers
  • Vestibular Neuronitis (see below)
  • Viral infections (labyrinthitis)
  • Acoustic Neuroma and other benign tumors (see below)
  • Postural hypertension (changes in blood pressure)
  • Low blood sugar
  • Low blood pressure
  • Stroke
  • Trauma or damage to sensory nerves
  • Diabetes
  • Various neurological disorders
  • Anxiety and hyperventilation
  • Systemic neurological disorders (such as Multiple Sclerosis, Parkinson’s disease and Alzheimer’s, although dizziness is not usually the main complaint or symptom)
  • Excessive alcohol consumption

Disorders that cause dizziness are categorized as peripheral (coming from the semicircular canals), central (coming from the brain or related pathways) or systemic (resulting from problems in the nerves or organs outside of the head, such as anemia, high blood pressure, diabetes, arthritis or cataracts and other eye problems.

Meniere’s Disease (also known as Endolymphatic Hydrops)

Classic symptoms of Meniere’s Disease include severe bouts of vertigo, tinnitus (usually described as “roaring”), fluctuating hearing loss and aural fullness (a feeling of pressure in the ears). Meniere’s Disease generally affects one ear but can occur in both ears. It is common to see the hearing loss start in the low pitches and gradually worsen to affect all of the frequencies tested during a routine audiogram. Hearing loss often fluctuates but eventually worsens to some degree of permanent hearing loss. The symptoms of Meniere’s are caused by changes in the volume of endolymph. What is thought to happen is that an over-abundance of endolymph “backs up” into the semicircular canals causing the canals to swell resulting in dysfunction.

Benign Positional Paroxysmal Vertigo (BPPV)

Individuals with BPPV experience dizziness and sometimes nausea after positional changes (i.e. rolling over, getting out of bed or tipping the head back). This is due to small crystals consisting of calcium carbonate, normally present within the inner ear, becoming displaced. This usually occurs due to head injury, infection or disorders of the inner ear. The most common cause of BPPV in the elderly population is degeneration of the vestibular system, while in the younger population it is commonly caused by trauma to the head. Symptoms are often intermittent and may cease for a period of time but may recur some time later. Medications such as Meclizine and Antivert will not cure the condition, but may provide temporary relief. The best treatment for this type of dizziness involves physical maneuvers and exercises that reposition the crystals back to their normal location. A cervical collar (soft neck brace) is generally worn for 48 hours after maneuvers are performed. These repositioning maneuvers are performed by a specially trained medical professional.

Vestibular Neuronitis

Usually involves severe dizziness but is not accompanied by hearing loss. This is thought to result from a viral infection of the vestibular nerve which caused it to be inflamed and/or irritated.

Acoustic Neuroma

This is a benign (non-cancerous), slow-growing tumor that develops along the hearing nerve and sometimes the vestibular nerve. The most common sign of an acoustic neuroma is hearing loss, however, dizziness can result when pressure on the nerve causes conflicting signals to be sent to the brain regarding the body’s position and movement.

Cholesteatoma

This is a collection of skin cells from the eardrum that form a growth in the middle ear. This is generally considered to be the result of repeated ear infections. If a cholesteatoma is not treated it can continue to grow and invade surrounding areas and structures. Depending on the direction of the growth, it can sometimes cause damage to the vestibular organs, causing dizziness and imbalance.

Determining the Cause of Your Dizziness

To determine the cause of your dizziness you first need a complete medical examination by your physician or otologist (ENT physician). Vision, blood pressure, heart rhythm and gait are typically assessed during your evaluation. An audiologic (diagnostic hearing) evaluation is often recommended as it provides valuable information to the physician about the functioning of your auditory system. Sometimes a referral to a neurologist is made. At Oregon Ear Nose and Throat Center, we diagnose the causes of these problems and, together with collaboration of your physician and associated vestibular physical therapists, we help you find relief from them. In the short term, a treatment plan can be designed to help you reduce the risks of falls and live more confidently with greater balance. For the long term, we can seek solutions that may alleviate or eliminate the cause of your balance issues.

Some Other Tests That Might Be Recommended or Ordered May Include:

  • Computed Tomographic (CT) Scan
  • Magnetic Resonance Imaging (MRI)
  • Laboratory Tests (Such as blood work or allergy testing)
  • Auditory Brainstem Response (ABR): Electrodes are placed on the forehead and in the ear canals. A clicking sound is then delivered to each ear. Electrical activity in the hearing nerve and brain stem is measured. This test essentially determines how well sound travels from your hearing nerve to the brainstem, and a comparison is made between the ears.
  • Electronystagmography (ENG): This test measures and records your eye movements as you perform a series of visual tasks and as you move into different body positions. During the final portion of the test, small amounts of both cold and warm water will be put in your ears. The test assists in pinpointing the source of the problem.
  • Electrocochleography (ECoG): Electrodes are placed on the forehead and in the ears. A clicking sound is delivered to each ear and changes in the electrical activity of the inner ear are measured and recorded.

Possible Forms of Treatment:

  • Vestibular Rehabilitation Therapy
  • Medication
  • Physical Maneuvers and exercises
  • Cervical Collar
  • Surgical Management
  • Balance Strengthening

Balance Resources

Balance problems can have many different causes, including circulatory issues, inner ear disturbances, or infection. Vertigo is the sensation of spinning or the room spinning around you. In contrast, disequilibrium is a feeling of off-balance or falling to one side. Lastly, pre-syncope is a feeling of nearly fainting or passing out.

Imbalance is especially troublesome in older adults, who are at a higher risk of falling. For younger individuals, balance issues can create problems both at home and work.

Helpful Hints When Dizzy

Here are tips to help diminish the dizziness:
  • Change your position slowly, especially when going from a lying down or sitting position to standing.
  • Look up or down slowly, and only for short periods of time.
  • Turn your head slowly from side to side and move your whole body when doing so.
  • Most cases of vertigo and dizziness are not serious, and either respond to treatment or improve over time. When changing positions quickly, older people sometimes experience dizziness due to circulatory problems.
  • Follow-up visits are important if the dizziness or vertigo persists.

Understanding Balance Problems

More than 2 million people visit their doctor each year complaining of dizziness. Some people describe their balance problem by saying that they feel dizzy or lightheaded. This feeling of imbalance without a sensation of spinning is rarely due to an inner ear problem. Other people describe their balance problem by using the word "vertigo", which in Latin means "to turn". They describe that either they or their surroundings are spinning. Vertigo is usually due to an inner ear problem.

Dizziness can be associated with a central problem resulting in not enough blood and oxygen getting to the brain. This may be due to arteriosclerosis, cervical osteoarthritis, diabetes or anemia, and generally occurs when getting up from a seated or reclining position.

Vertigo is usually due to an inner ear problem associated with the following conditions: Meniere’s disease, labyrinthitis, Eustachian tube blockage or benign positional vertigo. Usually one ear is affected more than the other. Other symptoms may include nausea, vomiting, fullness feeling in the ear, ringing in the ear, and hearing loss. People with true vertigo may have jerky eye movements called "nystagmus".

A complete medical evaluation is necessary to determine the cause of the dizziness or vertigo. The medical evaluation may include a hearing test, lab tests, videonystagmography (VNG), and a MRI. The medical evaluation, hearing test and VNG can be completed in our office.