Off Balance – Dizzy? The Key Is to Find the Cause

Not being able to balance can be a frightening experience. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain. Some people will be afraid to leave the house for fear of falling, and risk becoming isolated and depressed. Some exercise less and may stop taking medications they believe are causing the problem. A balance disorder is a condition that makes a person unsteady or dizzy, as they are moving, spinning or floating, even while they are standing still or lying down. One in three adults over 65 has a fall each year, said Mark Mailloux, a physical therapist at Portsmouth Regional Hospital. “There are three balance systems,” Mailloux said. “First is the vestibular — or inner ear — system that gives us a sense of up and down and where we are in space.” The second is a visual system. Having good peripheral vision plays a large role in balance, Mailloux said. Cataracts or other vision problems can reduce peripheral vision. The third is the somatosensory system, which controls the perception of body position and movement and muscular tensions. “A proper diagnosis equals a good outcome,” said Dr. Sally Fodero of New Hampshire Hearing and Balance in Greenland. Fodero said although there are many ear-related conditions that cause hearing loss along with vertigo symptoms, a complete audiological evaluation may help differentiate certain ear disease disorders from one another. “A medical history of the patient is critical as well,” she said. The sense of balance is primarily controlled by a maze-like structure in the inner ear that is called the labyrinth, which is made of bone and soft tissue. At one end of the labyrinth is an intricate system of loops and pouches called the semicircular canals, and the otolithic organs, which help maintain balance. At the other end is a snail-shaped organ called the cochlea, which enables hearing. The medical term for all of the parts of the inner ear involved with balance is the vestibular system. But other conditions such as a stroke event, post-concussion syndrome, early Parkinson’s disease, multiple sclerosis and migraine headaches may cause a patient to have problems with balance. It’s important for anyone experiencing symptoms of vertigo, dizziness, lightheadedness, imbalance or falls to be thoroughly evaluated. Mailloux said Portsmouth Regional’s rehabilitation department has a program for vestibular patients who are referred to the clinic by their doctors. “The gold standard of testing for vestibulopathy (inner ear disease) is videoystagmography,” Fodero said. During this test, eye movement is also checked for nystagmus, or uncontrolled eye movement. Additional tests check to see if the problem is related to an inner ear condition or the central nervous system. Patients with other balance disorders may be tested at Portsmouth Regional’s rehabilitation center on a Smart Balance Master. The patient stands in a half-enclosed cylinder with a harness for safety, and is asked to “lean” into the direction of an indicator on a video screen. The physical therapist measures the movements, comparing them to other people of the same age to see where the particular balance issue shows up. “It gives us a framework of where they’re at,” Mailloux said. Treatment for balance or conditions of the inner ear includes individualized plans with specific head, body and eye exercises to be performed both in a therapy setting and at home. Many times, treatment may also include increasing activities and exercise in order to strengthen muscles and increase tolerance for symptom-provoking stimuli such as loud noises or a sudden movement of the head in traffic. “It’s like recalibrating the brain, eyes and ears,” Fodero said. Treatments for other balance problems also are individualized as they may include physical therapy, exercise and, in some cases, medication. For additional information or to set an appt. Please contact Eartech Audiology at (866) 464-1008.  We acccept all insurances.