What are the common causes of dizziness and balance disorders. How do doctors diagnose balance issues. What treatment options are available for vertigo and other balance problems. How does the inner ear contribute to maintaining balance. What role do vision and other sensory inputs play in balance.

Understanding Dizziness and Balance Disorders

Dizziness is a broad term encompassing various symptoms related to balance and stability. It can manifest as a sense of motion, imbalance, lightheadedness, or even severe spinning sensations known as vertigo. To better understand these conditions, it’s essential to differentiate between the various types of dizziness:

• Dizziness: A general term for abnormal balance and stability symptoms
• Imbalance: Difficulty maintaining balance, especially while standing
• Lightheadedness: A feeling of nearly fainting
• Vertigo: The sensation of spinning or whirling

Balance disorders can significantly impact a person’s quality of life, affecting their ability to perform daily activities and increasing the risk of falls. Understanding the underlying causes and available treatment options is crucial for managing these conditions effectively.

The Anatomy of Balance: How Our Body Maintains Equilibrium

Maintaining balance is a complex process involving multiple systems in the body. The brain acts as the central processing center, integrating information from various sensory inputs to maintain equilibrium. The key components of the balance system include:

The Inner Ear

The inner ear plays a crucial role in balance and hearing. It consists of two main parts:

1. The cochlea: Responsible for hearing
2. The vestibular system: Responsible for balance

The vestibular system contains three semicircular canals filled with fluid called endolymph. These canals detect rotational movements of the head. Additionally, two small compartments with sensory cells covered in calcium crystals sense linear movements like swaying or rocking.

Vision

Our eyes provide important visual cues to the brain, helping us determine our position and movement relative to our surroundings. How does vision contribute to balance? Visual input allows us to orient ourselves in space and make necessary adjustments to maintain stability.

Proprioception

Proprioception refers to the body’s ability to sense its position in space. This information comes from sensory receptors in the muscles, joints, and skin, particularly in the feet and legs. These receptors provide crucial feedback about our body’s position and movement, helping us maintain balance.

Common Causes of Dizziness and Balance Disorders

Dizziness and balance disorders can stem from various sources, often related to different parts of the balance system. Some common causes include:

Inner Ear Disorders

Many balance issues originate in the inner ear. Some common inner ear disorders that can cause dizziness include:

• Meniere’s disease
• Benign Paroxysmal Positional Vertigo (BPPV)
• Labyrinthitis
• Vestibular neuritis
• Acoustic neuroma

These conditions typically cause vertigo, imbalance, and often nausea. For example, in Meniere’s disease, the endolymphatic sac fails to absorb enough fluid, leading to increased inner ear pressure and resulting in dizziness and hearing loss.

Neurological Disorders

Certain neurological conditions can affect the brain’s ability to process balance information, leading to dizziness. These may include:

• Migraines
• Multiple sclerosis
• Stroke
• Brain tumors

Cardiovascular Issues

Problems with blood flow can sometimes cause dizziness. Cardiovascular causes may include:

• Low blood pressure
• Arrhythmias
• Atherosclerosis

Diagnosing Balance Disorders: Advanced Techniques and Technologies

Accurate diagnosis is crucial for effective treatment of balance disorders. Modern ENT clinics, such as the Michigan Ear Institute, employ advanced diagnostic techniques to pinpoint the cause of dizziness. These may include:

Videonystagmography (VNG)

VNG is a test that uses video cameras to record eye movements during various maneuvers. How does VNG help diagnose balance disorders? By analyzing these eye movements, doctors can assess the function of the vestibular system and identify potential issues.

Rotary Chair Testing

This test involves sitting in a computerized chair that rotates at varying speeds while eye movements are recorded. It helps evaluate the vestibulo-ocular reflex, which is crucial for maintaining stable vision during head movements.

Posturography

Posturography assesses a patient’s balance by having them stand on a platform that can move or tilt. This test helps determine how well a person uses visual, vestibular, and proprioceptive information to maintain balance.

Audiometry

Since the hearing and balance systems are closely linked, a comprehensive hearing test can provide valuable information about potential inner ear disorders.

Treatment Options for Dizziness and Balance Disorders

The treatment for dizziness and balance disorders depends on the underlying cause. At specialized centers like the Dizziness, Balance, and Falls Center at the Michigan Ear Institute, treatment may involve a combination of approaches:

Medical Management

Medications can be prescribed to alleviate symptoms or treat underlying conditions. These may include:

• Antivertigo medications
• Antiemetics for nausea
• Diuretics for Meniere’s disease
• Migraine preventive medications

Vestibular Rehabilitation Therapy (VRT)

VRT is a specialized form of physical therapy designed to improve balance and reduce dizziness. How does vestibular rehabilitation work? It involves exercises that help the brain compensate for inner ear problems and improve overall balance function.

Canalith Repositioning Procedures

For BPPV, specific head maneuvers can be performed to relocate the displaced calcium crystals in the inner ear. The most common of these is the Epley maneuver.

Surgical Interventions

In some cases, surgery may be necessary to address the underlying cause of dizziness. Surgical options may include:

• Labyrinthectomy
• Vestibular nerve section
• Endolymphatic sac decompression

Living with Balance Disorders: Coping Strategies and Lifestyle Modifications

While medical treatments are essential, there are also lifestyle changes and coping strategies that can help manage dizziness and balance disorders:

Fall Prevention

Implementing fall prevention strategies at home is crucial for those with balance issues. This may include:

• Removing tripping hazards
• Installing handrails
• Improving lighting
• Using assistive devices when necessary

Dietary Changes

For some conditions, like Meniere’s disease, dietary modifications can help manage symptoms. This may involve:

• Reducing salt intake
• Limiting caffeine and alcohol consumption
• Staying hydrated

Stress Management

Stress can exacerbate dizziness in some individuals. Implementing stress-reduction techniques such as meditation, deep breathing exercises, or yoga can be beneficial.

Emerging Research and Future Directions in Balance Disorder Treatment

The field of balance disorder treatment is continually evolving, with ongoing research into new diagnostic tools and therapeutic approaches. Some promising areas of research include:

Vestibular Implants

Similar to cochlear implants for hearing loss, vestibular implants are being developed to restore balance function in individuals with severe vestibular disorders. How do vestibular implants work? These devices aim to replicate the function of the vestibular system by providing electrical stimulation to the vestibular nerve.

Gene Therapy

Researchers are exploring the potential of gene therapy to treat certain balance disorders, particularly those with a genetic component. This approach could potentially correct or replace faulty genes responsible for vestibular dysfunction.

Advanced Imaging Techniques

Developments in neuroimaging, such as functional MRI and PET scans, are providing new insights into how the brain processes balance information. These techniques may lead to more precise diagnoses and targeted treatments in the future.

Understanding dizziness and balance disorders is crucial for effective management and treatment. By recognizing the complex interplay of systems involved in maintaining balance and the various factors that can disrupt this delicate equilibrium, healthcare providers can offer more targeted and effective interventions. As research continues to advance, individuals suffering from these conditions can look forward to increasingly sophisticated and personalized treatment options, improving their quality of life and reducing the risk of falls and related complications.

Dizziness Treatment in Farmington Hills

At Michigan Ear Institute, our ENT doctors are highly trained in using the most advanced technology to diagnose balance and dizziness disorders, we use the diagnostic test to more accurately determine the best treatment path for you.

The Dizziness, Balance, and Falls Center at the Michigan Ear Institute has been recognized internationally as an outstanding clinical program for the diagnosis and treatment of balance disorders. After diagnosing the balance problem various treatment modalities including medical, surgical, and vestibular rehabilitation can improve overall balance function. Common balance disorders we see include Meniere’s disease, benign positional vertigo, vestibular neuritis, post traumatic dizziness, among other processes.

Dizziness and Balance Disturbances

Dizziness is a general term for many different symptoms. While it generally means an abnormal sensation of motion, it can also mean imbalance, lightheadedness, blacking out, staggering, disorientation, weakness and other sensations. Symptoms can range from mild and brief to severe spinning sensations accompanied by nausea also known as vertigo. For clarity the definitions we use to talk about dizziness are used.

Dizziness – A general term for all abnormal symptoms of balance and stability.

Imbalance – Inability to keep one’s balance especially when standing.

Lightheadedness – The feeling of nearly passing out, similar to the feeling you might have if you hold your breath for a long time.

Vertigo – The sensation that you or your surroundings are moving or spinning or whirling.

Balance requires the interaction between many different organs and systems in the body. The brain is the central processing center for all balance information coming from the senses and for all information going out to the muscles of balance. Input comes from three main areas: vision, the balance portion of the inner ear, and the touch (from the feet and joints). Vision is an important cue to the brain which tells us if we are moving relative to our surroundings.

Anatomy

There are two parts of hearing: mechanical and nerve (or electric). The mechanical part of hearing picks up sound from the outer ear canal and then vibrates the ear drum and the three tiny hearing bones in the middle ear. The inner ear looks a bit like a snail. It has two halves which are connected and are filled with fluid. The coil or cochlea takes care of the nerve part of hearing. Like a telephone it takes the vibration and turns it into an electric signal that is then relayed to the brain.

The other half of the inner ear is the balance or vestibular system. There are three balance canals, each set in different directions that respond to rotational movement of the head. Depending on which way you turn fluid, called end lymph, move within the canals and send the direction to the brain by way of the vestibular nerve.

There are also 2 small compartments that have sensory cells that are covered with small calcium crystals in a gelatin matrix. These compartments are responsible for sensing linear movement, such as swaying, rocking or bouncing movements. When the crystals of this compartment are dislodged, they may cause BPPV (benign paroxysmal vertigo).

The inner ear fluid undergoes a natural recycling every day. It is made from the brain’s spinal fluid and is absorbed by the endolymphatic sac. In Meniere’s syndrome the sac fails to absorb enough fluid. This increases inner ear pressure resulting in dizziness and hearing loss.

Also in close association with the ear is the facial nerve. It helps move the face and also provides for some of the taste to the tip of the tongue.

How Do You Maintain Balance?

Balance is maintained by the interactions in the brain of nerve impulses from the inner ear, the eye, the neck muscles, and the muscles and joints of the limbs. A disturbance in any of these areas may result in the subjective sensation of dizziness or unsteadiness. General disturbances of body function may lead to dizziness by interfering with coordination of the impulses of the brain.

What Causes Dizziness?

Dizziness can be grouped into types by the portion of the entire balance system that is not working properly. The different portions include the inner ear, the brain, the eyes and the limbs (neck, back, and leg muscles and joints which react to keep us upright).

Inner Ear Dizziness

Half of the inner ear is used for hearing (the cochlea) and the other half is used for balance (the labyrinth). If the labyrinth or the nerve that connects it to the brain is malfunctioning, dizziness can result. Many types of maladies occur in the inner ear to cause dizziness, including Meniere’s syndrome, labyrinthitis, positional vertigo, and vestibular neuritis, migraine and tumors of the inner ear nerves. These usually cause imbalance, vertigo (spinning), and nausea. It can also be accompanied by tinnitus and hearing loss, if the nearby cochlea is also affected. These diseases will be further explained.

Central Dizziness

Central dizziness is caused by problems in the balance portion of the brain. Anytime this portion of the brain is not working properly, dizziness can occur. Symptoms usually include lightheadedness, disorientation, imbalance, and sometimes even blacking out. Causes of central dizziness include low blood sugar, low blood pressure to the brain, strokes, multiple sclerosis, migraine headaches, head injury, tumors, and the aging process, among others. Treating these types of dizziness usual involves treating the problem which is causing the brain to not work properly.

Muscle-Joint Dizziness

This type of dizziness is uncommon. If the muscles, joints or touch sensors of the limbs are not working well, it becomes difficult for the body to react to motion, and makes it difficult to remain upright. Causes of muscle-joint dizziness include muscular dystrophy; sever diabetes, arthritis, joint replacements, and injuries. Symptoms are usually imbalance and unsteadiness.

Visual Dizziness

Eye muscle imbalance and poor vision can make one’s balance worse. The brain relies on information from the eyes to help with balance. Car sickness or sea sickness are types of visual dizziness because the eyes are constantly adjusting to a moving visual field and confuses the balance part of the brain. This can lead to dizziness, nausea and vomiting.

How is Dizziness Diagnosed?

Dizziness can be caused by numerous disturbances to any of many different parts of the body. Based upon your history and physical findings your physician may require further tests to complete a full evaluation. The tests necessary are determined at the time of examination and may include hearing and balance tests, imaging (CT or MRI scans), blood tests, and ultrasound tests. A general physical exam and neurological tests may also be needed.

The most common test for dizziness is the electronystagmogram (ENG) or videonystagmogram (VNG). In these tests the strength of the inner ear is tested as well as the coordination of eye movements. They involve watching the eye movements after placing warm or cool air into the ear canal. This usually causes a normal sensation of brief dizziness. It is important not to be taking any medications which can affect the test such as Valium, Antivert, alcohol and others. When scheduling this test make sure to ask if your medications will impact the outcome of the tests.

Other tests that are done for dizziness are the electrocochleography (ECoG) and Vestibular evoked myogenic potentials (VEMP). These painless tests may be useful in determining the cause of dizziness in complex cases.

The object of this evaluation is to be certain that there is no serious or life threatening disease and to pinpoint the exact site of the problem. This lays the groundwork for effective medical or surgical treatment.

Diagnosis can often be difficult. Frequently multiple tests must be conducted. Patience and understanding is necessary on the part of the doctor and patient alike.

Schedule an Appointment for Balance & Dizziness Treatment in Farmington Hills, MI

If you are experiencing symptoms of balance disorders schedule an appointment at our Dizziness, Balance and Falls Center. We will provide you with a comprehensive diagnosis to determine the root of your symptoms and the best treatment plan for you. Schedule an appointment today!

The Link Between Dizziness and Your Inner Ear: ENT Specialists: ENTs

The Link Between Dizziness and Your Inner Ear: ENT Specialists: ENTs

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It’s estimated that more than half of adults worldwide suffer from episodes of dizziness or vertigo, a related condition that makes it feel like the room is spinning around you. Yet even though dizziness is common, many people who suffer from dizziness don’t get the medical evaluation or treatment they need to feel better. 

Dizziness isn’t just uncomfortable — it can also lead to accidents like falls, the leading cause of injury-related death among older Americans. That means getting help for dizziness is especially important, not just for your quality of life, but for your health and safety, too.

Dizziness is often related to a problem with your inner ear, which has a direct influence on balance. At ENT Specialists, our team specializes in advanced diagnostic testing and state-of-the-art treatment for dizziness and vertigo at our locations in Salt Lake City, Murray, Tooele, Draper, and West Jordan, Utah. Here’s how your ears could be causing your dizziness symptoms.

Dizziness and the inner ear

Dizziness symptoms typically occur when one or more parts of your balance system are affected by disease, injury, or another problem. For many people, dizzy sensations emanate from their inner ear, which plays a major role in balance.

Your inner ear doesn’t just help you hear. It contains tiny hair cells and fluid-filled canals that help you keep your balance. When these cells, canals, or other structures in the inner ear are damaged, it can have a direct effect on your balance, causing sensations of dizziness and vertigo.

When dizziness is caused by a problem with the inner ear, your brain doesn’t receive correct information about your body’s position. As your body tries to interpret the information, you wind up feeling dizzy or like the room is spinning around you.

Sometimes, dizziness is also associated with hearing loss or a continual buzzing or ringing in your ears (a condition called tinnitus). Inner ear infections and Meniere’s disease are two possible causes of dizziness associated with hearing problems.

Some people have a condition called benign paroxysmal positional vertigo, or BPPV. In this condition, you’re more likely to feel dizziness or vertigo when you make a sudden change in head movement or when you stand up suddenly. BPPV can also occur following a blow to the head.

Treating dizziness

Dizziness can also be caused by problems with your eyesight, your brain, and other underlying diseases. Some types of medications can also contribute to sensations of dizziness. Before prescribing any treatment for dizziness symptoms, the team at ENT Specialists performs an in-depth exam and evaluation.

During your evaluation, you’ll be asked to provide details of your symptoms — when they occur, what they feel like, and how long they last. You’ll also be asked about your personal and family medical history and about medications you might be taking. Finally, our team will ask you about any recent illnesses, past injuries, or other symptoms associated with dizzy spells, like nausea, headache, or vomiting.

In many cases, you’ll be given a hearing test, and you may have diagnostic imaging studies, like X-rays or MRIs. Other tests may also be conducted, including:

• Blood tests
• Electrocardiogram
• Vision tests
• Tests of your inner ears

The doctor may also examine your throat and your sinuses, which are “connected” to your ears.

Depending on the results of your exam, your treatment might include:

• Balance exercises to restore your natural equilibrium
• Treatments for underlying medical conditions
• A change in medications
• Treatment for infection, of present
• Medications to help manage your symptoms

Don’t ignore your dizziness

Feeling dizzy might seem like a minor annoyance, but without treatment, chronic dizzy spells could increase your risks of accidents and serious injuries. At ENT Specialists, we can customize a dizziness treatment just for you, based on an in-depth evaluation and diagnosis of the cause of your symptoms. To get treatment for your dizzy feelings, call one of our five Utah locations or book an appointment online today.

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Meniere’s disease – causes, symptoms, diagnosis and treatment

• Meniere’s disease is a pathology of the inner ear of a non-infectious nature, manifested by dizziness, noise in the head and hearing impairment. In addition, patients are prone to anxiety disorders. Most often occurs in Europeans aged 20 to 50 years.

  Causes

  The etiology of the disease is still being studied, but there are several most promising theories:

  1. Anatomical (pathological structure of the temporal bone, incorrect arrangement of the elements of the inner ear).
  2. Immunological (antibodies to the tissues of the endolymphatic sac).
  3. Genetic (autosomal dominant type of inheritance).
  4. Vascular (often associated with migraine).
  5. Metabolic (excessive potassium in the endolymph).
  6. Allergic (most of the patients are allergic).

  Symptoms

  At the beginning of the disease, patients complain of tinnitus, stuffiness and hearing loss. These symptoms may be associated with dizziness, gait and coordination problems. Over time, excessive sweating, profuse salivation, diarrhea, arterial pressure lability join.

  More than a third of patients are prone to the presence of symptoms of depression and anxiety disorders. Less commonly, pathology is combined with a fear of open spaces and panic attacks.

  Stages of the disease

  There are three stages in the development of the disease:

  1. The first stage is dominated by dizziness with nausea and vomiting. The person is pale, the skin is covered with cold sweat. Before an attack, patients often report discomfort in the ear and a feeling of heaviness (or fullness) in the head.
  2. The second stage is formed sensorineural hearing loss. The perception of low frequencies decreases, dizziness becomes more frequent, other symptoms increase.
  3. The third stage is deafness. Attacks of dizziness are less and less, and then disappear altogether. Ataxia persists only in darkness.

  Diagnosis

  The otorhinolaryngologist takes a thorough history of the patient, conducts audiometry to determine the degree of hearing loss. In addition, it is necessary to carry out a series of tests:

  • Dehydration test (speech is heard better at low frequencies than other sounds).
  • Transtympal echocholerography.
  • Coordination tests (Romberg posture, Babinski-Weil test, Unterberg test, rotational test).
  • Cold and heat test.
  • Saccade test.

  Treatment

  During dizziness, the patient is advised to lie down, close the eyes and keep the head still until the nausea and tinnitus subside. Synthetic analogues of histamine are used to relieve seizures.

  In the interictal period, the patient is recommended to take drugs that reduce the amount of fluid in the body or reduce its pressure in the middle ear:
  – diuretics;
  – drugs that dilate blood vessels;
  – drugs that improve cerebral blood flow;
  – glucocorticosteroids;
  – antiallergic.

  In addition, acupuncture and training of the vestibular apparatus are used. If the treatment is not effective, the problem is eliminated surgically.

  The main complication is complete deafness, but unforeseen consequences are possible even after surgery. There is no cure for Meniere’s disease.

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Meniere’s disease: symptoms, signs and treatment

Meniere’s disease is treated by an otorhinolaryngologist

Meniere’s disease is a disease of the inner ear, manifested by systemic vertigo, sensorineural hearing loss, and subjective tinnitus.

The prevalence of the disease ranges from 3. 5 to 513 cases per 100,000 population in different countries. The disease suddenly strikes people aged 40-50, men and women equally. In 30% of cases, both labyrinths (both ears) are affected.

In the pathogenesis of Meniere’s disease, an important role is played by endolymphatic hydrops (dropsy) – an increase in the volume of endolymph that fills the membranous labyrinth of the inner ear and, as a result, its stretching with irritation of the receptors. Due to excessive pressure on the receptors, auditory and vestibular symptoms occur: hearing loss, subjective tinnitus, nystagmus (involuntary oscillatory eye movements), body deviation in space, nausea, vomiting, palpitations.

The etiology of this disease is not completely understood.

Stages of the disease

I (initial) stage. Characterized by intermittent or increasing tinnitus (low-frequency noise resembling the sound of the sea), a feeling of congestion or pressure in the ear, fluctuating (either increasing or decreasing) sensorineural hearing loss. Periodically there are attacks of systemic dizziness (a feeling of rotation of oneself or the surrounding space around) lasting from 20 minutes to 12 hours, accompanied by nausea and vomiting. Registered spontaneous nystagmus towards the irritated labyrinth. There are no complaints in the interictal period.

Stage II. It is characterized by severe clinical manifestations. Vertigo attacks last from 20 minutes to 12 hours, accompanied by tinnitus and sensorineural hearing loss, progressing with each subsequent attack of dizziness, as well as nausea and vomiting. According to the audiogram, fluctuating sensorineural hearing loss of II-III degree is recorded, which persists in the interictal period.

Stage III. Typical systemic vertigo is becoming more rare. Along with typical attacks of systemic dizziness, unsteadiness and instability of gait appear. Subjective tinnitus is constantly present, rarely increasing at the time of the attack. In the study of hearing according to audiometry, persistent sensorineural hearing loss (without fluctuation) is noted.

Criteria for diagnosis

• Two or more spontaneous attacks of vertigo lasting 20 minutes to 12 hours
• Audiometrically confirmed sensorineural hearing loss at low and medium frequencies before, during or after a vertigo attack
• Auditory symptoms – subjective noise, feeling of pressure (“fullness”) in the affected ear
• Excluded other diseases manifested by dizziness, balance disorder, hearing loss.

For the diagnosis of labyrinth hydrops, a dehydration test is performed (registration – in dynamics – tone threshold audiometry, speech intelligibility, otoacoustic emission after taking a dehydrating agent – diuretic) and electrocochleography (registration of electrical potentials that are generated in the inner ear and auditory nerve in response to sound stimulation).

To study vestibular function, videonystagmography or electronystagmography (nystagmus study) is performed with rotational and caloric tests.

Differential diagnosis

Meniere’s disease is differentiated (distinguished) from acute cerebrovascular accident, benign paroxysmal positional vertigo (BPPV), tumors of the cerebellopontine angle, vestibular neuronitis, multiple sclerosis and other diseases that can manifest as systemic vertigo.

It must be remembered that dizziness may occur when taking certain groups of drugs.

Treatment of Meniere’s disease

The goal of treatment is to stop or reduce the frequency of dizziness and reduce the severity of seizures, and prevent hearing loss.

During an attack, patients are advised to take a horizontal position, remain motionless, try to fix their eyes on any object. For treatment, vestibulolitics are used – drugs that relieve symptoms: antihistamines, antiemetics, as well as benzodiazepines and anticholinergics.

Diuretics, calcium channel blockers may be used in the interictal period.

Research into the efficacy of transtympanic (drug through the eardrum) use of glucocorticosteroids is ongoing. There are no unequivocal conclusions yet, the data obtained in the course of studies already conducted are not enough. There is also a controversial question about the advisability of using betahistine. The results of studies are contradictory, we are inclined to believe that its effectiveness is most likely commensurate with placebo.

In severe cases, transtympanic administration of gentamicin is used, an antibiotic that has a toxic effect on receptor cells, completely inhibiting the vestibular function on the side of the lesion. A side effect of the drug is a persistent hearing loss, so it is irrational to use this medicine in stages I and II of the disease.

In severe cases, surgical treatment is considered – operations on the endolymphatic sac, destruction of the labyrinth, transection of the vestibular part of the VIII cranial nerve.

Patients with Meniere’s disease are advised to change their lifestyle: adequate sleep, stress reduction, salt-free diet, avoidance of caffeine, alcohol and tobacco.