New Strategies Help Patients with Balance Disturbance

Imagine 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 often.

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.
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