Dizziness, Vertigo and Balance Disorders
What is “vertigo”?
Vertigo is a symptom, not a diagnosis. Vertigo is defined as the hallucination of motion. These motions can be “objective” — the patient perceives movement of the environment, or “subjective” — the patient perceives an internal sense of motion.
Objective vertigo is nearly always related to problems of the inner ear or the ear’s complex connections to the central nervous system. Subjective vertigo can be ear-related as well but can also have numerous other causes.
What can be done about my vertigo?
1. Diagnosis
The first step to solving the problem of vertigo is obtaining the correct diagnosis. This is often a complicated process. The history and physical examination remain the most important elements of the evaluation. Additionally, nearly all patients should undergo hearing testing to help evaluate inner ear function. Some patients may also require other audiological testing such as brainstem auditory evoked response testing (BAER), otoacoustic emissions (OAEs), electrocochleography (ECoG) and electro-or videonystagmography (ENG or VNG). Occasionally, radiological studies such as CT or MRI may be requested as well.
Not every patient requires every test.
The specialist analyzes the information gathered from the history and physical examination as well as the various diagnostic studies in order to determine the diagnosis.
2. Treatment
The treatment options vary greatly with the specific diagnosis. Some available treatments include: dietary changes, oral medications, instillation of medication into the middle ear, positional maneuvers, vestibular rehabilitation (specialized physical therapy), and surgery.
Balance Disorders
Balance problems are extremely common, particularly in senior citizens. Falls are among the leading causes of fatal and non-fatal injuries in the elderly.
Our balance depends mostly on the function of 3 systems:
1. Vision
Our eyes give us important information in reference to our orientation, position, and movement relative to our environment.2. Proprioception (position sense)
Provides information regarding our orientation relative to gravity. When a person leans, he should be able to feel the shift in pressure of his feet against the floor. Similarly, there should be some detection of leaning in the muscles of the trunk.3. Vestibular
The inner ear balance system is responsible for maintaining balance and equilibrium, particularly during motion.
In general, if there is weakness in one of these systems, the remaining 2 systems should allow the individual to compensate and to maintain balance under most conditions. If the weakness in one system is overwhelming, or if there is weakness in more than one system, imbalance may result. There are numerous other health, fitness and environmental factors that can that can contribute to balance disorders.
The primary goals of the balance evaluation are to determine which of these systems is contributing to the imbalance and to determine if there is an underlying disorder that requires treatment.
In nearly all cases, measures can be taken to help improve balance and to reduce the risks of falls and injury.
