Vertigo/Balance

DIZZINESS & BALANCE DISORDERS
Dizziness is a condition that can range from mild dizziness to vertigo (spinning, swaying, swimming or rotatory movement). When balance is impaired, an individual has difficulty maintaining orientation. For example, an individual may experience the "room spinning" and may not be able to walk without staggering, or may not even be able to arise or cannot even get out of bed. The most common complaints of dizziness are lightheadedness, loss of balance, feeling of faintness or disorientation, unsteadiness, feeling of falling, swaying, swimming or rocking, a sensation that the room is spinning. Vision problems may also occur such as difficulty to focus the eyes on an object or the sensation that objects are moving.
Some individuals may also experience nausea and vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, anxiety, or panic. Some reactions to the symptoms are fatigue, depression, and decreased concentration. The symptoms may appear and disappear over short time periods or may last for a longer period of time.
Dizziness and symptoms of imbalance may be accompanied by ear- or hearing related symptoms such as: Tinnitus (ringing in the ears), a feeling of pressure or fullness of the ears or in one ear, hearing loss, hypersensitivity for loud sounds.

CAUSES OF DIZZINESS & BALANCE DISORDERS
Balance is regulated by the body's vestibular system, an intricate tiny network of fluid-filled sacs located in the inner ear. The vestibular system works with the eyes, bones and joints, and brain to regulate the body's position. Balance problems occur when one or more of these are not operating correctly.
Infections (viral or bacterial), head injury, disorders of blood circulation affecting the inner ear or brain, certain medications, and aging may change our balance system and result in a balance problem. Individuals who have illnesses, brain disorders, or injuries of the visual or skeletal systems, such as eye muscle imbalance and arthritis, may also experience balance difficulties. A conflict of signals to the brain about the sensation of movement can cause motion sickness (for instance, when an individual tries to read while riding in a car). Some symptoms of motion sickness are dizziness, sweating, nausea, vomiting, and generalized discomfort. Balance disorders can be due to problems in any of four areas:
1. Peripheral vestibular disorder, a disturbance in the labyrinth.
2. Central vestibular disorder, a problem in the brain or its connecting nerves.
3. Systemic disorder, a problem of the body other than the head and brain.
4. Vascular disorder, or blood flow problems.

HOW DO THE BALANCE SYSTEM & VESTIBULAR ORGAN WORK?
An organ in the inner ear, the labyrinth, is an important part of our vestibular (balance) system. Please note that there is a difference between the inner ear and middle ear. The middle ear is the area air-filled space behind the eardrum, where the three middle ear bones (ossicles) are situated. The inner ear is filled with fluid and is posterior to the middle ear. The labyrinth interacts with other systems in the body, such as the visual (eyes) and skeletal (bones and joints) systems, to maintain the body's position. These systems, along with the brain and the nervous system, can be the source of balance problems.

Three structures of the labyrinth, the semicircular canals, let us know when we are in a rotary (circular) motion. The semicircular canals, the superior, posterior, and horizontal, are fluid-filled. Motion of the fluid tells us if we are moving. The semicircular canals and the visual and skeletal systems have specific functions. The interaction of these systems gives an individual the sense of orientation in space. The vestibule is the region of the inner ear where the semicircular canals meet, close to the cochlea (the hearing organ). The balance & vestibular works with the visual system to keep objects in focus when the head is moving. Joint and muscle receptors also are important in maintaining balance. The brain receives, interprets, and processes the information from these systems that control our balance.




TREATMENT FOR DIZZINESS & BALANCE DISORDERS
Treatment for dizziness is necessary when symptoms are severe and persistent. Anti-nausea medications and prescription sedatives can help patients cope with their dizziness, but don't heal the condition. The side effects of these drugs may also increase the chances of falling by delaying a person's reaction time. The best method is to treat the underlying cause of the dizziness or imbalance, such as an inner ear infection. However, if it is not possible to treat the problem medically or surgically, the next step is to deal with the dizziness itself. That's where an audiologist comes in.

HOW CAN AUDIOLOGISTS HELP WITH DIZZINESS & BALANCE DISORDERS?
Audiology is the science of treating individuals with hearing- or balance problems. Audiologists are trained to perform hearing and balance tests to help determine possible causes of dizziness or balance disorders. Tests that help diagnose inner ear disorders such as dizziness and loss of balance, are available at many audiology clinics.
Treatment for dizziness varies depending upon the type of dizziness and the severity of it. In the case of dizziness caused by an ear infection, a course of antibiotics often clears up the problem. Changes in diet, such as a reduction in fluids and salt, are often successful in helping treat Meniere's disease, an inner ear fluid balance disorder. More severe cases of dizziness will require balance retraining exercises called vestibular rehabilitation.

WHAT TO EXPECT AT THE AUDIOLOGIST
During a consultation, the audiologist takes a detailed history of the symptoms, records the patient's medical history, examines the ears, and performs a hearing test. The audiologist then conducts different balance tests to determine the origin of the problem. Next, the audiologist performs some tests to assess the cause of the dizziness and determine the extent of it.
An audiologist will possibly perform a bedside balance examination as well as sophisticated computerized tests such as:

Electronystagmography (ENG) test
This test is useful in determining what is or is not causing dizziness and in identifying how or if the inner ear is working. The Electronystagmography (ENG) records and measures involuntary eye movement, or nystagmus, that occurs when a person becomes dizzy. During this test, electrodes are taped onto the skin around the eyes. In the first part of the test, the patient watches lights move on a light bar. In the second part of the test, the patient's head and body is moved into different positions to see where the dizziness is provoked. The third part of the ENG is called the caloric test. In this test, warm and cool air or water is put into the ear canal in order to stimulate the balance organs and determine if they are functioning properly. During the ENG, the audiologist records the patterns of normal and abnormal eye movements.

Videonystagmography (VNG) test
This test is similar to the Electronystagmography (ENG)test, but is performed with video imaging technology. The patient wears video goggles with infrared cameras while going through the test. The cameras measure the involuntary eye movements and display them on a screen.
Other tests such as posturography, rotational chair testing, dynamic visual acuity etc. may also be performed.
The main aim of a balance & dizziness examination is to determine the cause and proper treatment for the dizziness.

COMMON TYPES OF DIZZINESS OR BALANCE DISORDERS
Bilateral Vestibular Dysfunction
This condition occurs when there is weakness on both sides of the vestibular system. Symptoms include imbalance, loss of surefootedness, and an illusion that objects are bouncing up and down with movement.

Benign Paroxysmal Positional Vertigo (BPPV)
This condition is the leading cause of dizziness. It occurs when salt-like crystals (calcium-carbonate crystals) in the inner ear break free and float throughout the ear canal. A patient with this condition will experience a brief but intense vertigo that is caused by a change of head position.

Labyrinthitis
This condition is an inner ear infection or inflammation that causes dizziness, severe vertigo, nausea, and vomiting.

Meniere's disease
This is an inner ear fluid balance disorder. It occurs when there is a buildup of fluid pressure in the ear. Symptoms include sudden vertigo lasting 30 minutes or longer, fluctuating hearing loss, tinnitus, and a sensation of fullness or pressure in the ear.
Unilateral Vestibular Dysfunction
This condition occurs when there is weakness on one side of the vestibular system. Symptoms include positional vertigo, dizziness when turning the head, and motion sickness.

AUDIOLOGICAL TREATMENT FOR DIZZINESS & BALANCE DISORDERS
Audiologists can provide rehabilitation for a patient or participate in a multi-disciplinary team approach that includes an otolaryngologist (ear, nose, and throat specialist), neuro-otologists (an ear, nose, and throat doctor that specializes in balance & hearing disorders), neurologist, occupational therapist, physio-therapist, and/or a general practitioner to work up a treatment plan.

Vestibular Rehabilitation Therapy (VRT)
These are balance retraining exercise programs, individually designed for the individual, in order to decrease dizziness and improve balance through simple head, eye, and body movements. This therapy is most successful in treating vestibular dysfunction. It helps retrain the brain thereby lessening or eliminating symptoms. Many audiologists provide limited vestibular rehabilitation treatment. They may refer the patient to a physio-therapist or occupational therapist for this therapy.

Canalith Repositioning Therapy (CRT)
This is the most well-known treatment for Benign Paroxysmal Positional Vertigo (BPPV). In this treatment the patient's head is moved into several different positions. The goal is to move the crystals out of the ear canal. This treatment is often a one-time office visit and has a 90% success rate.