Everyone has a dizzy spell now and then, but “dizziness” can mean different things to different people. For one person, dizziness might mean a fleeting feeling of faintness, while for another, it could be an intense sensation of spinning (vertigo) that lasts a long time. Certain health conditions, medications, or problems in the inner ear or the brain can cause balance disorders. A balance disorder can profoundly affect daily activities and cause psychological and emotional hardship. What are the symptoms of a balance disorder? If you have a balance disorder, your symptoms might include the following:
What causes balance disorders?
Causes of balance problems include medications, ear infections, a head injury, or anything else that affects the inner ear or brain. Low blood pressure can lead to dizziness when you stand up too quickly. Problems that affect the skeletal or visual systems, such as arthritis or an eye muscle imbalance, can also cause balance disorders. Your risk of having balance problems increases as you get older. Unfortunately, many balance disorders start suddenly and with no apparent cause. How Does My Body Keep Its Balance? Your sense of balance relies on signals to your brain from several organs and structures in your body, specifically your eyes, ears, and the muscles and touch sensors in your legs. The part of the ear that assists in balance is known as the vestibular system, or the labyrinth, a maze-like structure in your inner ear made of bone and soft tissue. Within the labyrinth are structures known as semicircular canals. The semicircular canals contain three fluid-filled ducts forming loops arranged roughly at right angles. They tell your brain when your head rotates. Inside each canal is a gelatin-like structure called the cupula [KEW-pyew-lah], stretched like a thick sail that blocks off one end of each canal. The cupula sits on a cluster of sensory hair cells. Each hair cell has tiny, thin extensions called stereocilia that protrude into the cupula. When you turn your head, fluid inside the semicircular canals moves, causing the cupulae to flex or billow like sails in the wind, which bends the stereocilia. This bending sends a nerve signal to your brain to tell it which way your head has turned. Between the semicircular canals and the cochlea (a snail-shaped, fluid-filled structure in the inner ear) lie two otolithic [oh-toe-LITH-ic] organs: fluid-filled pouches called the utricle [YOU-trih-cull] and the saccule [SACK-kewl]. These organs tell your brain the position of your head to gravity, such as whether you are sitting up, leaning back, or lying down, as well as any direction your head might be moving, such as side to side, up or down, forward or backward. The utricle and the saccule also have sensory hair cells lining the floor or wall of each organ, with stereocilia extending into an overlying gel-like layer. Here, the gel contains tiny, dense grains of calcium carbonate called otoconia [oh-toe-CONE-ee-ah]. Whatever the position of your head, gravity pulls on these grains, which then move the stereocilia to signal your head's position to your brain. Any head movement creates a signal that tells your brain about the change in head position. When you move, your vestibular system detects mechanical forces, including gravity, that stimulate the semicircular canals and the otolithic organs. These organs work with other sensory systems in your body, such as your vision and your musculoskeletal sensory system, to control the position of your body at rest or in motion. It helps you maintain a stable posture and balance while walking or running. It also lets you keep a steady visual focus on objects when your body changes position. When the signals from any of these sensory systems malfunction, you can have problems with your sense of balance, including dizziness or vertigo. If you have additional issues with motor control, such as weakness, slowness, tremors, or rigidity, you can lose your ability to recover appropriately from imbalance. It raises the risk of falling and injury. What are some types of balance disorders? There are more than a dozen different balance disorders. Some of the most common are:
How are balance disorders diagnosed? Diagnosis of a balance disorder is difficult. To determine if you have a balance problem, your primary doctor may suggest you see an otolaryngologist and an audiologist. An otolaryngologist is a physician and surgeon specializing in diseases and disorders of the ear, nose, neck, and throat. An audiologist is a clinician who specializes in the function of the hearing and vestibular systems. You may be asked to participate in a hearing examination, blood tests, a video nystagmogram (a test that measures eye movements and the muscles that control them), or imaging studies of your head and brain. Another possible test is called posturography. You stand on a movable platform before a patterned screen for this test. Posturography measures how well you can maintain a steady balance during different platform conditions, such as standing on an unfixed, movable surface. Other tests may also be performed, such as rotational chair testing, brisk head-shaking testing, or even tests that measure eye or neck muscle responses to brief sound clicks. The vestibular system is complex, so multiple tests may be needed to best evaluate the cause of your balance problem. How are balance disorders treated? The first thing an otolaryngologist will do if you have a balance problem is determine if another health condition or a medication is to blame. If so, your doctor will treat the disease, suggest a different remedy, or refer you to a specialist if the condition is outside their expertise. If you have BPPV, your otolaryngologist or audiologist might perform simple movements, such as the Epley maneuver, to help dislodge the otoconia from the semicircular canal. In many cases, one session works; other people need the procedure several times to relieve their dizziness. If you are diagnosed with Ménière's disease, your otolaryngologist may recommend changing your diet and, if you are a smoker, stop smoking. Anti-vertigo or anti-nausea medications may relieve your symptoms but can also make you drowsy. Other medications, such as gentamicin (an antibiotic) or corticosteroids, may be used. Although gentamicin may reduce dizziness better than corticosteroids, it occasionally causes permanent hearing loss. In some severe cases of Ménière's disease, surgery on the vestibular organs may be needed. Some people with a balance disorder may not be able to relieve their dizziness fully and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan. Talk to your doctor about whether it's safe to drive and how to lower your risk of falling and getting hurt during daily activities, such as walking up or down stairs, using the bathroom, or exercising. Avoid walking in the dark to reduce your risk of injury from dizziness. Wear low-heeled shoes or walking shoes outdoors. Use a cane or walker and modify conditions at home and workplace, such as adding handrails. When should I seek help if I think I have a balance disorder? Ask yourself the following questions to help you decide whether to seek medical help for dizziness or balance problems. If you answer “yes” to any of these questions, talk to your doctor:
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