Dizziness, vertigo, or loss of balance is the second most common complaint heard in doctors’ offices. NIH statistics indicate that dizziness will occur in 70% of the nation’s population at some point in their lives. Although very common, problems with equilibrium may indicate serious health risks and often impacts quality of life. 

Equilibrium disorders fall into two categories. First is dizziness, vertigo, or motion intolerance that may occur in attacks which can last from seconds to several hours.  This condition may be caused or worsened by rapid head movements, turning too quickly, walking, or riding. 

The second is a persistent sense of imbalance, unsteadiness or what some people refer to as a loss of surefootedness. 

The good news is that diagnosis and treatment options have become more effective over the past ten years. There is hope for many who once thought that there might be no relief. 

Loss of Balance

Many people believe that loss of balance and unsteadiness are a natural result of aging. In fact, fear of falling is the number one health concern of individuals in their later years—not unfounded as the NIH statistics indicate that balance related falls account for half of accidental deaths in the population over 65 years of age. In addition, nearly 300,000 hip fractures and 3 billion dollars in medical expense result rom balance related falls each year. 

Human equilibrium is a complex interaction which requires correct input from the inner ear, vision, and somatosensory (contact with the earth as perceived by our feet, muscles, and joints.) All three signals must then execute the correct movement of our musculoskeletal system so that we may maintain our center of gravity. If any of these systems are not working properly, the patient will suffer loss of balance. 

The natural aging process may affect one or all these senses, as well as the brain’s ability to quickly interpret these signals and then to react quickly. It is very common to hear from someone who has fallen that they saw the curb or the step but just weren’t able to react fast enough or keep their balance. 

With proper diagnosis and therapeutic exercises, called Vestibular Rehabilitation Therapy (VRT), or Balance Retraining, may older adults are able to return to more active lives. 

Did you know? 

• Vertigo, dizziness, or imbalance will affect 90 million Americans at some point in their lives.
• Each year over 9 million people consult with their doctors with complaints of dizziness – the number one concern for those over 70 years of age. 
• Balance related falls account for more than one half of the accidental deaths in the elderly.
• Balance related falls cause over 300,000 hip fractures a year in individuals over 65 years of age.
• Many times, disorders of the inner ear are misdiagnosed as a more severe neurological condition such as multiple sclerosis or depression. 
• Inner ear disturbances account for more than 85 % of dizzy disorders.
• Children with treatable vestibular disorders are sometimes incorrectly diagnosed with learning disabilities, dyslexic, or psychologically impaired. 
• Blows to the head and whiplash are frequent causes of imbalance, dizziness, and vertigo.
• Ear infections respiratory viruses can also lead to vestibular disorders. 
  

Dizziness, Vertigo, Motion Intolerance

The primary organ of equilibrium in the human body is located in the inner ear which serves as both the sensory organ for special orientation and head movement as well as hearing. 

If for any reason there is an abnormal increase or decrease in the signal being sent to the brain, from any of the balance canals, the brain will perceive this as an exaggeration or hallucination of motion.  The result is what we commonly term dizziness or vertigo. 

Illness, infections, disease, head trauma, and the natural process of aging may cause changes in the equilibrium portion of the inner ear. For others, motion sickness may be traced to their early childhood. Motion intolerance may be experienced as either a sense of exaggerated motion or an inability to watch moving objects while stationary. 

Although symptoms may only last for several days it is not uncommon, if left improperly diagnosed or treated, for symptoms to linger for years. The good news is that 90% of all causes of dizziness can be found through a thorough evaluation. Of those, 85 % are caused by inner ear disturbance and can be treated medically, surgically, or with Vestibular Rehabilitation Therapy (VRT.)

Patient Self Quiz

• A feeling of motion, spinning, or falling when moving your head quickly, or changing your position, e.g., getting in and out of bed?   
• Uncomfortable trying to get around in the dark?
• Walking down grocery store isles or through the mall is upsetting?
• Your feet just won’t go where you want them to?
• A sense of unsteadiness?
• A fear of falling or stumbling?
• Looking at moving objects or looking out the car window makes you queasy?
• Difficulty keeping you balance on uneven surfaces?
• A feeling like you are drifting or being pulled to one side when walking?
• No one really understands how frustrating all this is?

If you answered YES to one or more of these questions, a vestibular and equilibrium evaluation should be considered. 

Benign Paroxysmal Positional Vertigo

The #1 type of vertigo is caused by the displacement and lack of absorption of calcium gravity sensors in the inner ear. More common in females than males, it affects all ages and genders, but is 3 times more common in migraine patients. It may also be caused by a mild head trauma or inner ear infections. This vertigo may be triggered by a change in head position, lying flat, or when looking up, the vertigo lasting no more than 30 seconds, but during this time is feels very frightening and may cause nausea and vomiting. It may feel like being on a wild amusement park ride. 

What is BPPV?

This is the name for the type of vertigo that occurs quickly without warning if you simply lay flat, on your side, or simply turning your head. Vertigo describes that awful feeling that the world is spinning around you. Although vertigo from BPPV lasts less than a minute, it may make you feel ill and frightened and may cause an unexpected fall. BPPV may occur in children and adults and is the most common form of Vertigo, especially as we age, affecting 50% of all people by age 70. 

Why does BPPV Occur?

The balance part of the inner ear works like a gyroscope and helps control the body’s response to gravity and head movement. Inside the balance portion of the inner ear is a system that detects gravity and movement made up of calcium carbonate crystal-like substances called otoconia which means “ear stones”. It is normal for these crystals to loosen and fall into one of the balance canals where our body should naturally dissolve within a few hours. When these crystals don’t dissolve, however, the extra weight of the crystals cause nerve receptors to be improperly stimulated when the head moves. 

Many things may contribute to difficulty in the absorption of these crystals including normal aging and poor calcium absorption associated with low vitamin D levels, influence of medications, head trauma, and ear infections. It is also more common in persons with cardiovascular issues, diabetes, and history of migraine.

Good news…It is easily treated without medicine or surgery!

Canalith Repositioning is the physical maneuver treatment which has successfully been used to treat BPPV for the past 25 years. The treatment only takes minutes and is successful in treating 95% of patients, usually in less than 3-4 treatments. This maneuver helps the crystals move through the balance canals, out into another part if the inner ear where they can be dissolved within a day or so. Each year, researchers are developing even better, more effective treatments. 

Will it come back?

Researchers now know that BPPV, once treated, may recur if the individuals are prone to low vitamin D levels or suffer from certain chronic medical conditions. The best thing to do is discuss with your physician or healthcare provider to be sure that your vitamin D levels are checked as a part of your regular annual visit. If BPPV does recur, treatment is easy, comfortable, and highly successful without the need for medications or surgery. 

BPPV of Childhood

A form of pediatric migraine, with greater female incidence, the onset is typically seen between the ages of 1-4 years. These short-lived episodes can be frightening as the child becomes disoriented and may stagger and fall. Episodes are usually accompanied by nausea and vomiting. It often appears as a seizure-like event. Although the child will typically “grow out” of it by age 5-6, nearly 50% will develop migraine at puberty. 

Cardiovascular Concerns and Dizziness

Cardiovascular issues may be contributing to dizziness and balance problems more than is commonly recognized. One of the most obvious causes of cardiovascular related dizziness is orthostatic hypotension. This condition manifests as sensations of lightheadedness, dizziness, and disequilibrium upon rising from a seated or lying position, typically lasting for less than a minute. Cardiovascular disease can also contribute to dizziness and vertigo. The blood supply to the inner ear balance system is quite tiny; any disruption from cardiovascular origins can impair blood flow thus impairing the function of the balance system, leading to dizziness and balance problems.

Vestibular migraine

Migraine is classified as a neurological genetic disorder affecting one and four females. Although males are also subject a migraine, it is 3:1 female dominant. Onset may coincide with puberty and is usually most active during the childbearing years, often improving after menopause. Because of its link to hormonal changes, it may improve or worsen with pregnancy, contraceptives, and hysterectomy or hormone replacement therapy. Because migraine is sometimes misunderstood and often goes undiagnosed, there are many variations many of which do not include headache at all. 25% of all people with migraine have dizziness, vertigo, or changes in vision as a symptom without any headache. Today, migraine may be successfully managed with medications and lifestyle changes such as diet and exercise. 

Shingles and vestibular neuritis

Most common in people over 50 years of age, it is a remnant of the childhood chickenpox virus. When the immune system is suppressed, this form of the herpes simplex virus causes an outbreak of painful blisters. It is especially fond of causing an inflammation of the balance nerve, causing severe vertigo, usually with nausea and vomiting. It may also affect the facial nerve causing facial paralysis, or the auditory nerve affecting hearing and balance. This condition often results in prolonged motion provoked dizziness or imbalance, which may be evaluated and treated in collaboration with the patient’s audiologist and physician.

Age onset Falls

The NIH have identified age related falls as a healthcare crisis. Falls for the older adult have a devastating impact, resulting in fractures, traumatic brain injuries (TBIs), and loss of independence. The primary cause of falls is due to the loss of strength in the legs and lack of feeling in the feet and toes from a peripheral neuropathy related to diabetes or peripheral arterial disease. This is made far worse by untreated dizziness, vertigo, or visual conditions including glaucoma and macular degeneration. The good news is… falls are no longer accepted as a natural part of aging. Today, with the use of physician fall risk assessment, and intervention including vestibular rehabilitation training and fall recovery strategies, older adults are enjoying fall free and independent living. 

Viagra, Cialis, and the ears

According to the archives of otolaryngology head and neck surgery, men who have taken Viagra, or other PDE-5 inhibitors, are more likely to report the sudden hearing loss in one or both ears as well as tinnitus. Men have taken Viagra or other PDE-5 inhibitors at any time were twice as likely to report hearing loss than men who have never taken it. That causes thought to be due to increase blood flow to the structures of the inner ear hearing mechanism, which causes damage.

Sports related concussions

Many athletes, or former athletes, have experienced a concussion. Many times, the concussion has gone undiagnosed, or the symptoms were so mild that no medical intervention was sought. Youngsters participating in activities like rollerblading, skateboarding, or bicycling should use proper headgear to prevent concussion from a fall. Concussion may cause cognitive, physical, and/or emotional symptoms including dizziness, nausea, imbalance, trouble concentrating, difficulty sleeping, difficulty reading, and irritability. Most concussion symptoms improve in 7 to 10 days; however, anyone experiencing a sport or activity related head trauma should see if physician.  

10 Myths About Falls 

• MYTH 1 Falling happens to other people, not me.
• MYTH 2 Falling is something normal that happens as you get older.
• MYTH 3 If I limit my activity, I won't fall.
• MYTH 4 If I stay at home, I can avoid falling.
• MYTH 5 Muscle strength and flexibility can't be regained.
• MYTH 6 Taking medication doesn't increase my risk of falling.
• MYTH 7 I don't need to get my vision checked every year.
• MYTH 8 Using a walker or cane will make me more dependent.
• MYTH 9 I don't need to talk to my family members or my healthcare provider if I'm concerned about my risk of falling. I don't want to alarm them, and I want to keep my independence.
• MYTH 10 I don't need to talk to my parent, spouse, or other adult if I'm concerned about their risk of falling. It will hurt their feelings and it's none of my business.
  

Fall proof your Home

• Improve lighting
• Remove things you can trip over. Keep your path clear and objects off the floor. Remove small throw rugs. Watch out for your pets.
• Keep items commonly used in easy reach. Avoid stepstools.
• Install grab bars in the bathroom and stairways. Use nonslip mats in the bathtub
• Wear appropriate and well-fitting shoes avoid wearing flip-flops