Dizziness & Balance

DR GEORGE explains that a balance disorder is a disturbance that causes you to feel unsteady, giddy, or have a sensation of movement, spinning, or floating.

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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.

HOW DOES THE BALANCE SYSTEM WORK?

As can be seen in the  diagram, 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 and it is movement of this fluid that sends signals to the brain about the direction and speed of rotation of the head - for example, whether we are nodding our head up and down, or looking from right to left.  Two other organs that are part of the vestibular system are the utricle and saccule. These are called the otolithic organs and are responsible for detecting linear acceleration, or movement in a straight line.

The balance system works with the visual and skeletal systems (the muscles and joints and their sensors) to maintain orientation or balance. For example, visual signals are sent to the brain about the body's position in relation to its surroundings. These signals are processed by the brain, and compared to information from the vestibular and the skeletal systems.

WHAT ARE THE SYMPTOMS OF A BALANCE DISORDER?

When balance is impaired a person has difficulty maintaining orientation. For example, you may experience the "room spinning" and may not be able to walk without staggering, or may not even be able to get up. 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

  Light-headedness

  Visual blurring

  Disorientation

Some people may also experience nausea and vomiting, diarrhoea, 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. People 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 (i.e. when a person tries to read while riding in a car). Some symptoms of motion sickness are dizziness, sweating, nausea, vomiting, and general 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 - blood flow problems

WHAT TYPES OF BALANCE DISORDERS ARE THERE?

Some of the more common balance disorders are:

BENINGN PAROXYSMAL POSITIONAL VERTIGO (BPPV): a brief, intense sensation of vertigo that occurs because of a specific positional change of the head. An individual may experience BPPV when rolling over to the left or right upon getting out of bed in the morning, or when looking up for an object on a high shelf.

LABYRINTHITIS: an infection or inflammation of the inner ear causing dizziness and loss of balance.

MENIERE'S DISEASE: an inner ear fluid balance disorder that causes episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears), and the sensation of fullness in the ear. The cause of Meniere's disease is unknown.

VESTIBULAT NEURONITIS: an infection of the vestibular nerve.

PERILYMPH FISTULA: a leakage of inner ear fluid to the middle ear which can occur after a head injury or physical exertion.

HOW ARE BALANCE DISORDERS DIAGNOSED?

Diagnosis can be complicated as there are many kinds of balance disorders and because other medical conditions - including ear infections, blood pressure changes, some vision problems and some medications - may contribute to a balance disorder. A person experiencing dizziness should see a Doctor for an evaluation. The Doctor may require tests to assess the cause and extent of the disruption of balance. The kinds of tests needed will vary based on the patient's symptoms and health status.

An Otolaryngologist (ENT) is a doctor/surgeon who specialises in diseases and disorders of the ear, nose, throat, head and neck, with expertise in balance disorders. He or she will usually obtain a detailed medical history and perform a physical examination to determine possible causes of the balance disorder. The ENT might refer you to a Clinical Audiologist for a vestibular test called a Videonystagmography (VNG). It is a series of tests used to determine whether the dizziness may be caused due to an inner ear condition.  The test works by recording, analysing and reporting involuntary eye movements, called nystagmus, using video imaging technology. 

There are five main parts to the VNG:

  The saccade test evaluates rapid eye movements.

  The tracking test evaluates movement of the eyes as they follow a visual target.

  The positional test measures dizziness associated with positions of the head.

  The caloric test measures responses to warm and cold air or water circulated through a small, soft tube in the ear canal.

  The cameras record the eye movements and display them on a video/computer screen that allows the examiner to see how the eyes move which is very helpful in assessing balance system health.

HOW ARE THE BALANCE DISORDERS TREATED?

Your Doctor or ENT will determine if your dizziness is caused by a medical condition or medication. Individual treatment will vary and will be based upon symptoms, medical history, general health, examination, and the results of medical tests. 

Your Doctor may also talk to you about balance retraining exercises (vestibular rehabilitation) that include movements of the head and body specifically developed for the individual.

Dietary changes may be suggested in certain cases.  For people diagnosed with Meniere's disease, dietary changes such as reducing intake of sodium (salt), alcohol, caffeine (coffee/tea etc.), and/or avoiding nicotine (smoking) may be helpful.

WHERE CAN I GET MORE PROFESSIONAL ADVICE?

If you are concerned whether you may be suffering from a Balance Disorder contact DR GEORGE Hearing Centers - to make an appointment click here to send an email, or phone us on 77 77 65 00.