Dizziness and Balance Disorders
At Coates Hearing Clinic, our hearing specialists provide comprehensive care for virtually all dizziness and balance disorders. Our office is outfitted with state-of-the-art equipment that allows extensive testing to evaluate the causes of dizziness and balance problems. We have a number of different tools at our disposal to evaluate patients of all ages with all types of complaints.
Once the proper evaluation and testing have been done to get a correct diagnosis, your hearing specialist will help counsel you as to your treatment options. Treatments may vary depending on the nature of the disorder.
Dizziness is a symptom, defined as a sensation of unsteadiness, imbalance, or disorientation in relation to an individual’s surroundings–it is not a disease. The symptoms of dizziness vary widely from person to person and can be caused by many different diseases. They vary from a mild unsteadiness to a severe whirling sensation known as vertigo. Because the symptoms of dizziness vary so widely from patient to patient and may be caused by many different diseases, the physician commonly requires testing to be able to provide the patient with some knowledge about the cause of his/her dizziness. Dizziness may or may not be accompanied by a hearing impairment.
Identifying Balance Problems
Balance problems may occur alone or in association with a hearing issue. Vertigo, which refers to the sensation of the room spinning, is the primary symptom of ear-related balance problems. A thorough physical examination is important in the evaluation of vertigo. Additionally, specialized balance testing may be indicated to help determine exactly what part of the balance system has been compromised. Once a proper diagnosis is made, a combination of medication and therapy may be used to rehabilitate the balance system.
Common Dizziness and Balance Disorders
Acute or chronic problems with balance may indicate serious health risks and affect a person’s quality of life. The first step to getting better is proper diagnosis.
The following are some of the most common dizziness and balance disorders.
- Benign Paroxysmal
- Positional Vertigo (BPPV)
- Vestibular Neuritis/Labyrinthitis
- Migraine – Associated Dizziness
- Meniere’s Disease
- Acoustic Neuroma
- Perilymph Fistula
- Superior Canal Dehiscence
- Vascular Dizziness
- Natural Aging Process
Benign Paroxysmal Positional Vertigo (BPPV). BPPV is one of the most common types of dizziness. This disorder can be seen following a head injury, vestibular neuronitis, Meniere’s disease, or can present alone. Simple everyday movements such as rolling over in bed, sitting up, or bending over can trigger vertigo (spinning sensation).
BPPV can be treated with repositioning maneuvers. Repositioning progressively moves the canalith out of the semicircular canals into the utricle. When the crystals are in the utricle, they cannot trigger dizziness. Since BPPV can recur, repositioning is sometimes repeated.
At Coates Hearing Clinic, our hearing specialists are trained to perform positional vertigo treatment. Once you have a confirmed diagnosis, you can schedule an appointment online and request this specific service.
Vestibular Neuritis/Labyrinthitis. Vestibular Neuritis is an inflammation of the auditory/vestibular nerve usually caused by a virus. The inflammation can change or reduce the output of one or both of the balance portions of the inner ear to the brain. This inaccurate inner ear information results in severe dizziness and vertigo. Fortunately, vestibular neuritis usually subsides in time and usually does not recur.
When the inflammation affects the auditory portion of the nerve, it causes hearing loss in addition to dizziness and is called labyrinthitis. Certain medications can help in the initial phases to decrease severe symptoms. However, long-term use of medications can actually impede full recovery. Balance exercises (vestibular rehabilitation) can be the most effective treatment for the symptoms associated with vestibular neuritis.
Migraine – Associated Dizziness. Migraines are thought to be caused by vasoconstriction of cranial vessels or neuronal dysfunction. Changes in nerve cell activity and blood flow may result in symptoms such as visual disturbances, vertigo (spinning), motion intolerance, positional vertigo, photophobia (light sensitivity), misophonia (sound sensitivity), and nausea. Migraine associated dizziness may be due to the constriction of blood supply to the cochlear and/or vestibular system. Evaluation for migraine-associated dizziness includes a hearing evaluation, a complete case history, videonystagmography (VNG), and a neurology consultation. Migraine medications have been shown to reduce migraine-associated dizziness successfully.
Meniere’s Disease. Meniere’s disease is relatively rare compared to other more common disorders such as vestibular neuritis and benign paroxysmal positional vertigo. A typical Meniere’s attack involves severe spinning vertigo with imbalance, nausea. and vomiting. Characteristically, the attacks are accompanied by fluctuations of hearing and sometimes tinnitus (ringing in the ears). Most patients with Meniere’s Disease describe fullness in one or both ears. The attacks can last for hours but fatigue and nausea may persist for days. Meniere’s Disease is caused by abnormal accumulations of fluid in the inner ear and increases in inner ear pressure. The diagnosis is often made with an accurate history, a hearing test, and specialized tests such as videonystagmography, vestibular evoked myogenic potentials, and videocochleography. The treatment consists of medications, a special low salt diet, and surgery (rarely). Vestibular rehabilitation is considered to be helpful only in cases of persistent, non-fluctuating inner ear injury.
Ototoxicity. This is the term used to describe damage to the ear caused by toxic substances. This occurs when individuals come into contact with drugs or chemicals that are poisonous to the inner ear or to the nerve that supplies the inner ear (vestibulocochlear nerve). Because the inner ear is involved in both hearing and balance, ototoxicity can result in problems with either one or both of these senses. Symptoms vary considerably from drug to drug and person to person. They range from mild imbalance to severe vertigo and from tinnitus (ringing in the ears) to total hearing loss. If symptoms involve both the right and left inner ears, the patient may not have vertigo, but severe imbalance and blurred vision caused by poor stabilization of the eyes.
Tests that may be used to determine how much hearing or balance function has been lost include videonystagmography (VNG), auditory brainstem response (ABR), and a hearing evaluation. The treatment consists of eliminating or reducing exposure to ototoxic substances and participating in a vestibular rehabilitation program to promote greater use of vision and muscle sensory information (proprioception).
Acoustic Neuroma. Only about 2,000 cases are diagnosed in the United States each year. An acoustic neuroma is a benign tumor on the vestibular portion of the eighth cranial nerve, which connects the inner ear to the brain. An acoustic neuroma may cause vertigo (spinning), unsteadiness, imbalance, or lightheadedness in addition to hearing loss and/or ringing in the affected ear. Most acoustic neuromas are removed by surgery. Other options, including various types of radiation therapy (often called radiosurgery), are available.
Perilymph Fistula. This is a tear or defect in the oval window or round window (the thin membranes between the middle and inner ears). When a fistula is present, changes in middle ear pressure will directly affect the inner ear stimulating the balance and/or hearing structures and causing dizziness, vertigo, imbalance, nausea, and vomiting. Individuals may experience ringing, fullness, and/or hearing loss. Symptoms typically worsen with changes in altitude such as elevators, airplanes, or travel over mountains. Additionally, strenuous activity or straining can trigger symptoms. Head trauma is the most common cause of perilymph fistula. However, other activities such as weight lifting or scuba diving can cause a perilymph fistula. Often a fistula can be diagnosed by applying pressure to the ear while measuring eye movements. Perilymph fistulas can heal spontaneously with rest, but sometimes surgery is required.
Superior Canal Dehiscence. This is a balance disorder resulting from a hole in the bone overlying the superior (uppermost) semicircular canal within the inner ear. This abnormal opening can cause dizziness, nausea, and vestibular hyperacusis (vertigo and imbalance triggered by sound). Superior canal dehiscence is thought to result from a congenital condition in which the bone over the superior canal is thinner than normal and thus more vulnerable to damage from gradual erosion or from forces such as violent coughing or a blow to the head. The diagnosis of superior canal dehiscence includes a hearing evaluation, tympanometry, videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP), and bone-imaging studies such as a CT scan. Treatment involves surgically patching the bone overlying the superior (uppermost) semicircular canal followed by vestibular rehabilitation therapy.
Vascular Dizziness. The proper function of the balance system requires not only the input for the inner ear but also the appropriate nerve connections in the brain. If the areas of the brain that assist in balance do not get enough blood, even temporarily, dizziness can occur. The causes of vascular dizziness are varied. Arthritis in the neck can cause compression of arteries to the head, cholesterol plaques may narrow the arteries in the brain, and fluctuations in blood pressure may cause dizziness. Special testing such as videonystagmography (VNG), MRI, or Doppler tests may be needed to diagnose these problems accurately.
Natural Aging Process. Loss of balance and unsteadiness are common changes seen as a function of aging. Fear of falling is the number one health concern of individuals in their later years. Vestibular rehabilitation programs have been very successful in helping patients with fall prevention and improved balance and coordination. A complete case history and videonystagmography (VNG) evaluation are necessary to determine whether the imbalance is due to the aging process or other medical conditions. They are also necessary to help ensure an appropriate treatment plan.