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Dizziness, Vertigo & Imbalance

What is a balance disorder?

A balance disorder is a disturbance that causes an individual to feel unsteady, giddy, woozy, or have a sensation of movement, spinning, or floating. An organ in our inner ear, the labyrinth, is an important part of our vestibular (balance) system. 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 that determine an individual's orientation. The vestibule is the region of the inner ear where the semicircular canals converge, close to the cochlea (the hearing organ). The vestibular system 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.


What are the symptoms of a balance disorder?

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.

Some of the symptoms a person with a balance disorder may experience are:

  • A sensation of dizziness or vertigo (spinning)
  • Falling or a feeling of falling
  • Lightheadedness or feeling woozy
  • Visual blurring
  • Disorientation

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.


What causes a balance disorder?

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:

  • Peripheral vestibular disorder, a disturbance in the labyrinth
  • Central vestibular disorder, a problem in the brain or its connecting nerves
  • Systemic disorder, a problem of the body other than the head and brain
  • Vascular disorder, or blood flow problems

More information can be found at the Vestibular Disorders Association www.vestibular.org.


Videonystagmography (VNG)

VNG is a test used to evaluate patients experiencing dizziness, vertigo or imbalance. Dizziness and imbalance are common symptoms that can be caused by a variety of factors. Commonly, however, the inner ear system is involved. VNG evaluates the inner ear by using the connections between the inner ear and the eye muscles to determine if this is the cause of your dizzy complaints. During the test, you will wear goggles to monitor your eye movements. You will be asked to follow a light with your eyes and recordings will be made with your head and body in different positions. Finally, cool and warm water will be put into your ears. It is not uncommon for this test to cause dizziness. However, the dizziness is brief, usually lasting less than a few minutes, and most often the dizziness is mild.

Length of exam: As long as two hours

Pre-Test Preparation: Do not eat or drink for at least 4 hours prior to the exam unless you are diabetic in which case please maintain your normal eating schedule, do not take medications that have been prescribed for dizziness for 48 hours before the exam, do continue to take other medications especially for cardiac, diabetes and blood pressure problems, do not wear eye make-up to the appointment (if you do, you will be asked to remove it).


Vestibular Evoked Myogenic Potentials (VEMP)

VEMP testing is commonly performed on patients complaining of dizziness, vertigo or imbalance, and is often conducted during the same visit as the VNG evaluation to obtain a comprehensive understanding of your inner ear function. The purpose of the VEMP evaluation is to determine if portions of your inner ear, specifically an organ called the saccule, as well as a branch of the auditory nerve, are intact and working normally. The test involves placing electrodes about your neck and putting earphones into your ear which will produce a rather loud clicking sound. You will be asked to recline in a chair and to raise then hold your head up for about one minute. This cycle will be repeated several times.

Length of exam: As long as one hour

Pre-Test Preparation: Do not wear a turtleneck shirt, do not take any medications that have been prescribed for dizziness for 48 hours before the exam.


Epley (Canalith Repositioning) Maneuver

One of the most common causes of dizziness is Benign Paroxysmal Positional Vertigo or BPPV. BPPV is caused by calcium particles that become lodged in areas of the inner ear where they should not be. When this occurs, it can cause you to experience a brief spinning sensation when your head is put in certain positions. Commonly, people with BPPV report dizziness when they look up, bend over or roll over in bed. Fortunately, BPPV is highly treatable with a procedure called canalith repositioning.

Because of the connection between your inner ear and your eye muscles, you will wear goggles to monitor your eye movements during the exam. The audiologist will guide you from a sitting position into a reclined position to determine where in the inner ear the calcium particles have lodged. From there, the audiologist will maneuver your head and body to roll the particles out of the problem area. While BPPV is often resolved after the first treatment, additional treatments are sometimes necessary.

Length of Exam: As long as one hour

Pre-test Preparation: None. However, it is recommended that following the treatment, you avoid activities that would have brought about your dizzy symptoms for the remainder of the day.

 

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