Why does my wife keep falling over?
MY WIFE, who is 83 and generally in good health, has had difficulty in controlling her balance and loses confidence after slight falls. I wonder if she has i nner ear trouble, as I understand that tablets are obtainable for this problem.
A. A. Gibson, Sutton, Surrey.
HOW very upsetting for both of you. This situation cannot go on and efforts must be undertaken to find the cause of the falls that are so robbing your wife of her confidence.
Maintaining your balance is no simple feat, but a complex biological process that’s dependent upon your brain receiving i nformation f rom three systems: the first is vision, the second is the balance mechanism of the inner ear, and the third is something called proprioception, or joint sense — which involves the brain receiving information about the angle of your limbs and spine.
Balance also depends on the ability of your various muscles to act in a co-ordinated way to keep you in position.
Your blood pressure is important, too, because if it falls the brain may not receive enough blood flow, which means it is not able to process the information received from the other systems.
So it’s a complex process that can fail for a number of reasons, including ear problems (causing dizziness), weakness of the legs, arthritis, being female ( older women have weaker muscles than men f or poorly understood reasons), medicines (especially those that act in the brain, such as tranquillisers or antidepressants), and a history of stroke.
ONE of the tests doctors use in assessing a patient’s balance is the ‘get up and go test’. This involves watching the patient rise from a chair, walk across the room, turn around, walk back to the chair, and then sit down.
Observing this helps identify problems with muscle strength, balance, a nd g e neral coordination — and may give clues as to the exact diagnosis. You ask if an inner ear problem may be to blame for your wife’s instability. Problems with the inner ear can cause vertigo, the sensation of spinning — the same feeling we experience after twisting round rapidly a few times.
Possible causes include inflammation of the nerves that carry signals from the inner ear to the brain, or Meniere’s disease, where there is a build up of fluid in the inner ear which can also muddle the messages sent to the brain.
And so my response to your question i s that your wife’s instability may be due to an inner ear problem, but this is not the only possibility. You must ask your doctor to analyse the precise cause, and a physiotherapist might then be able to help with exercises. This will help develop strength around the joints and help her hold body positions. The best of luck to you both. FOR LONGER than I can recall I have had what I can only describe as a cold that won’t go away, sometimes with mucus draining into the back of my throat. My GP put me on a course of antibiotics which helped but I have still got the sneezing and running nose.
J.F. Faulkner, Harrogate, North Yorkshire. LONG-TERM nasal catarrh, often with symptoms of blockage, sneezing, cough, and even loss of sense of smell, is a miserable affliction. We use the term chronic rhinitis to describe this collection of symptoms, and the task for the GP or ear, nose and throat specialist is to track down the cause so treatment can be precise and effective.
Ninety per cent of the time it’s allergy related — the patient will usually have spotted this if the symptoms are seasonal, f or example starting in March or April when various trees come in to flower. It’s more difficult to spot when the symptoms occur all the year round and it’s a chal- lenge to detect the allergen involved. But very often it’s the dust mite.
Too tiny to be seen by the human eye, the insects live on shed human skin, which is pretty offputting really. But like cows grazing on grass, the house dust mite feeds on flakes of our skin, mixed with fibres from the fabrics with which we surround ourselves.
EVEN more unpleasant is the fact that the allergy from which many of us suffer is a response to the faeces of the mite.
Other year-round allergens we may react to are feathers in pillows, domestic pets, even building products such as MDF or chipboard — in particular those bound with resin glues that leach tiny amounts of the chemical irritant formalin into the air.
In the other 10 per cent of chronic rhinitis the causes include hormonal conditions (‘atrophic’ rhinitis, for instance, is linked to the menopause) or even the irritation caused by acid reflux.
If your doctor is not able to help you work out whether your chronic rhinitis is allergic or non-allergic, it may be necessary to see a specialist, in which case you will undergo skin tests for allergy and possibly other investigations. When it comes to treatment, the most effective therapy for patients with allergic rhinitis or chronic non-allergic rhinitis is a steroid.
Your best course of action would be to seek referral to a ear, nose and throat specialist so as to be fully investigated.
There is every prospect that your annoying symptoms can be stopped.
WRITE TO DR SCURR
TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email
drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter i nto personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.