Dizziness can be a drag: Coping with balance disorders
Imagine reaching for something on a grocery shelf and suddenly feeling unsteady. Or looking over your shoulder to back up the car and having things start whirling around you.
Most people feel dizzy now and then. But if that feeling persists or interferes with your daily life, it could be a sign of a balance disorder.
A balance disorder makes you feel as if you’re moving, spinning or floating, even though you’re quite still. More than 4 in 10 Americans will experience an episode of dizziness sometime during their lives that’s significant enough to send them to a doctor.
Dizziness can range from feeling lightheaded to woozy to disoriented. Feeling that you or your surroundings are spinning is called vertigo. Any of these sensations can be extremely distressing.
“Balance is a multisystem function,” explains NIH hearing and balance expert Dr Daniel Sklare. It begins with a series of signals within the tiny balance organs of the inner ear. These organs work with your brain’s visual system to give you a sense of your body’s position. They also keep objects from blurring when your head moves.
Sense receptors in skin, joints and muscles also send balance-related signals to the brain. The brain receives and coordinates information from all these different body systems. Balance disorders can arise when any of these signals malfunction.
Because balance is so complex, it can be hard to figure out the underlying cause of certain problems. Some balance disorders can begin suddenly. They might arise from an ear infection, a head injury or certain medications. Low blood pressure can lead to dizziness when you stand up quickly. Disorders related to vision, muscles, bones or joints can also contribute to balance problems.
“As America gets older, many people with imbalance have a collection of these problems,” says Dr Gordon Hughes, NIH clinical trials director for hearing and balance. “They might have aging of the ear, aging of vision, cataracts, muscle weakness from losing some muscle mass or arthritis in the hips, plus other problems like diabetes.”
Researchers have identified more than a dozen different balance disorders. The most common is a sudden, often harmless burst of vertigo that might arise with an abrupt change in the position of the head, like when you bend over to tie your shoes.
Technically known as benign paroxysmal positional vertigo (BPPV), this condition can result from a head injury or simply from getting older. BPPV sometimes occurs when tiny calcium crystals (otoconia) in the inner ear become displaced. In that case, your doctor can treat BPPV by carefully moving the head and body to reposition these particles. An NIH-supported clinical trial showed that this treatment works well for BPPV.
About Ménière’s disease
Another common balance disorder is known as Ménière’s disease. It can develop at any age, but most often strikes adults between 40 and 60 years of age. Symptoms include intense vertigo, hearing loss, nausea, tinnitus (a ringing or buzzing in the ear) and a feeling of fullness in the ear. Ménière’s disease usually affects only one ear.
Tell your doctor
Discuss your symptoms with a healthcare provider if:
You often feel unsteady.
You feel as if the room is spinning around you.
You feel as if you’re moving when you’re standing or sitting still.
You lose your balance and fall.
You feel as if you’re falling.
You feel lightheaded, or as if you might faint.
Your vision becomes blurred.
You sometimes feel disoriented
You sometimes lose your sense of time, place or identity.
Some people with Ménière’s disease have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some affected people have vertigo so extreme that they lose their balance and fall. These episodes are called “drop attacks.”
An attack of Ménière’s symptoms, while not life-threatening, can feel completely overwhelming. The symptoms arise because of a change in fluid volume within the inner ear. But its underlying cause remains unknown. Scientists estimate that 6 in 10 people either get better on their own or can control their vertigo with diet, drugs or devices. In severe cases, surgical therapies can end the dizziness but might affect hearing.
NIH-funded researchers at the University of Washington are now exploring a new treatment option to stop a Ménière’s attack. An implant behind the ear is designed to control abnormal electrical activity in the nerve that sends balance information to the brain, bringing the sensation of spinning to a halt. The device is now being tested in clinical trials.
Do you have a balance problem?
If you think you may have a balance disorder, talk with your health care provider. Your doctor can assess whether your symptoms might be caused by a serious disorder, such as a heart or blood condition. If an inner ear balance disorder is likely, you may be referred to a specialist such as an otolaryngologist, a doctor with expertise in the ear, nose and throat. You might receive a hearing test, a balance test and possibly an imaging study of the brain.
Work with your doctor to figure out how to cope with your dizziness on a daily basis and reduce your risk of injury. For example, wear low-heeled shoes or walking shoes outdoors, and you might decide to try using a cane or walker. Safe, secure handrails in stairwells and grip handles in bathrooms can help make your home safer. Driving a car may be especially hazardous, so ask your doctor if it’s safe for you to drive.
A specialized rehabilitation therapist can give you a set of head, body and eye exercises to help reduce dizziness and nausea.
Meanwhile, researchers continue to work to develop new, more effective approaches. In one experimental rehabilitation strategy, now in clinical trials, scientists have created a “virtual reality” grocery store. It allows people with balance disorders to walk safely on a treadmill through computer-generated store aisles. While holding onto a grocery cart, they can look up and down, turn their heads and reach for items on virtual shelves. By doing this, they safely learn how to navigate an environment that can be challenging for someone with a balance problem.
“The key for people looking for treatment is to go to the best team of clinical experts that they can gain access to,” says Dr Sklare. “It’s very important to get that level of assessment.”
Image: Side-lying test for the diagnosis of right PC-BPPV
Below: Side-lying test for the diagnosis of right PC-BPPV. After seating the patient on the examination table (A), the head is turned 45° away from the involved ear (B). The patient then lies on the side of the involved ear (C). The corresponding illustrations demonstrate the orientation of the semicircular canals and location of the otolithic debris in the posterior canal (viewed from the front). PC-BPPV: posterior canal benign paroxysmal positional vertigo. Provided via NIH/Open Access Subset of PubMed Central (PMC).