that you are on vacation and having a wonderful time. Midway through
your trip, you awaken one morning and find the world spinning and
you are unable to stop it. You try to get out of bed and find that
it makes you very ill and you fall back into the bed , feeling nauseous.
The one difference in this story from that of hundreds of thousands
of balance disorder sufferers is that you are on vacation, away from
the doctors and nurses you may know at home.
Balance problems can strike swiftly, without warning, and can be extremely
debilitating. Each year, thousands of Americans are hospitalized for
rapid onset of vertigo. In past years physicians have been able to
provide little more than modest symptomatic relief using antihistamines
and other medicines which cause sedation and suppression of the feeling
of dizziness. New treatment strategies provide doctors and their patients
with much more rapid relief than the therapies of the past.
Numerous health problems can be responsible for balance difficulties.
Balance disturbance sufferers may have a feeling of unsteadiness,
or dizziness, or they may complain of lightheadedness. Some sufferers
may find that they are fine until they turn their head in one certain
position. At that moment the feeling of whirling loss of balance rapidly
develops. Some people develop a spinning , floating feeling called
vertigo when they have a flare-up of allergy problems. Others may
feel short-winded and may have an associated tightness in their chest.
It is helpful to try and think of the possible causes of balance problems
in different groups. Low blood sugar, blood pressure problems, hormone
deficiencies, brain problems, heart trouble, and inner ear trouble
can all cause difficulties with balance. Identifying the cause can
sometimes be quite difficult. Spells of brief duration which cause
the sufferer to fall down and partially lose consciousness are usually
thought to be related to low blood pressure or hypotension. Frequently
this can be due to medication for high blood pressure. Heart trouble
with irregular heartbeat may cause such spells as well. A drop in
blood sugar could also cause such an event. Feelings of unsteadiness
or lightheadedness may be associated with decreased oxygen blood levels
also. Patients with severe lung disease may have this feeling quite
In patients who have dizziness or vertigo without other apparent causes,
their doctor may consult an Otorhinolaryngologist to assist in evaluating
the function of the inner ear. Such a specialist, often referred to
as an ENT doctor, may request a number of special types of testing
of both the balance function and the hearing function of the inner
ear. This testing is usually performed by a colleague of the ENT doctor
known as an Audiologist. These special tests may offer clues in their
results which might help identify a probable cause of balance disorder.
Medical Science has relied for centuries on the correlation of disease
complaint and observation of the affected body with the tissue condition
observation seen in visual evaluation and microscopic inspection of
a surgically removed organ or mass. Inner ear disease and brain disease
pose unusual challenges to scientific identification of a cause of
disease. Patients, as you might imagine, may be quite willing to have
a small mass removed from the throat or the skin. This same patient
may be reasonably reluctant to have the inner ear removed for such
inspection for something less than a malignancy. For this reason,
the diagnosis of specific inner ear problems requires the specialist
to rely on educated assumptions in achieving a working diagnosis.
Inner ear problems have been described in a number of patterns.
New treatment options for some of these patterns are dramatically
improving the treatment success for affected patients. Benign Paroxysmal
Positional Vertigo is a good example. In past years, patients
were often told that this problem, causing vertigo in a certain position
while causing no symptoms in other postitions, would eventually go
away. They were placed on medications to suppress the balance dysfunction
but no true treatment was available. Now, patients with BPPV
are pushed through a sequence of maneuvers which are designed to float
tiny sand stones in the inner ear back into a neutral location. Often,
patients who have suffered with BPPV are dramatically better in one
or two days after the Canalith repositioning, or Epley maneuver(after
John Epley, the Otologist who initially described the maneuver).
Acute vertigo, a whirling disconnected feeling of loss of balance,
may come from multiple causes. Meniere's syndrome, described
in the late 1800's by Prosper Meniere, is a collection of symptoms
which do not have a clearly defined single cause. Meniere's sufferers
experience balance disturbance which is usually vertigo. Many
patients also describe a roaring noise which is called tinnitus.
Hearing may be impaired and may later return to normal. During
attacks, the affected ear may feel an unusual fullness and
be described as being closed or stopped up. Patients who suffer from
Meniere's syndrome may experience all of these symptoms or may only
experience one or two in brief spells. In severe cases, the fluctuating
hearing loss and vertigo may occur often and for sustained periods.
In patients such as this, the ear may eventually lose function permanently.
Patients with Meniere's syndrome may notice symptoms first in one
ear, only to have symptoms develop later in the other ear. It is thought
that the artist van Gogh suffered with severe Meneire's syndrome.
Meniere's sufferers have been treated with variable success with diuretic
medications to relieve fluid pressure in the inner ear. .For years,
surgery, decompressing the fluid filled endolymphatic sac,
has been successful for some patients. New techniques aimed at placing
steroid medicines similar to hydrocortisone into the middle ear and
allowing it to diffuse across the round window membrane into the inner
ear, have shown significant success. Some patients find relief with
intermittent treatment through a tube placed in the eardrum in the
office. Repeat treatments may be necessary as frequently as every
three to five days or as rarely as once per month. A new type of special
catheter and micro pump has been developed and is sometimes used to
push micro doses of medications through the round window membrane.
In many cases, this has been found to be very helpful in controlling
the symptoms for Meneire's sufferers.
An association has also been discovered between Meniere's syndrome
and allergic disease. Many cases are found where the patient is discovered
to have food allergy to a specific food or additive in the diet. Other
patients with sudden, severe vertigo are found to have an associated
allergy attack from inhalant allergens. In these cases, patients may
be placed on IV or oral steroid medications for a short period of
time. Many vertigo sufferers who require admission to the hospital
can gain significant relief in a matter of hours with IV steroid medications.
Many patients may be treated as an outpatient with oral steroid medications.
Antihistamine therapy will likely also be prescribed in order to prevent
further attacks. Combined medications and consideration for possible
surgery in the endolymphatic sac or for placement of the inner ear
catheter or a tube in the ear to allow infusion of drugs may be advised
for Meniere's patients.
All patients with balance disturbances should undergo evaluation and
may have the specialist order advanced inner ear testing both for
hearing and for balance. Some patients may be told to have a cardiac
evaluation also. Many patients who have abnormal results on the specialized
hearing testing will be asked to undergo a special brain imaging scan
called an MRI, or magnetic resonance imaging test. This test can allow
a careful computerized look inside the skull and brain. The MRI is
the best test to identify possible tumors in the brain or brainstem
which are rare causes of dysequilibrium and hearing loss.
Your family doctor will be the best health professional to contact
initially for help with new onset disturbances in balance. An initial
exam can help guide you toward early treatment or further evaluation
to help eliminate balance disturbances. You may be treated with medicine
for blood sugar or dizziness or perhaps referred to a heart specialist,
or an ear specialist, or a neurology brain specialist depending on
your family doctors initial impression. With new treatments for balance
problems, early evaluation and early treatment may help to prevent
the underlying condition from irreversibly deteriorating.