Dizzi­ness Can Be a Drag

Cop­ing with Bal­ance Dis­or­ders

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If you think you may have a bal­ance dis­or­der, talk with your health care provider. Your doc­tor can as­sess whether your symp­toms might be caused by a se­ri­ous dis­or­der, such as a heart or blood con­di­tion.

Imag­ine reach­ing for some­thing on a gro­cery shelf and sud­denly feel­ing un­steady. Or look­ing over your shoul­der to back up the car and hav­ing things start whirling around you. Most peo­ple feel dizzy now and then. But if that feel­ing per­sists or in­ter­feres with your daily life, it could be a sign of a bal­ance dis­or­der. A bal­ance dis­or­der makes you feel as if you’re mov­ing, spin­ning or float­ing, even though you’re quite still. More than 4 in 10 Amer­i­cans will ex­pe­ri­ence an episode of dizzi­ness some­time dur­ing their lives that’s sig­nif­i­cant enough to send them to a doc­tor. Dizzi­ness can range from feel­ing light­headed to woozy to disori­ented. Feel­ing that you or your sur­round­ings are spin­ning is called vertigo. Any of th­ese sen­sa­tions can be ex­tremely dis­tress­ing.

“Bal­ance is a mul­ti­sys­tem func­tion,” ex­plains NIH hear­ing and bal­ance ex­pert Dr. Daniel Sklare. It be­gins with a se­ries of sig­nals within the tiny bal­ance or­gans of the in­ner ear. Th­ese or­gans work with your brain’s vis­ual sys­tem to give you a sense of your body’s po­si­tion. They also keep ob­jects from blur­ring when your head moves. Sense re­cep­tors in skin, joints and mus­cles also send bal­ance-re­lated sig­nals to the brain. The brain re­ceives and co­or­di­nates in­for­ma­tion from all th­ese dif­fer­ent body sys­tems. Bal­ance dis­or­ders can arise when any of th­ese sig­nals mal­func­tion. Be­cause bal­ance is so com­plex, it can be hard to fig­ure out the un­der­ly­ing cause of cer­tain prob­lems. Some bal­ance dis­or­ders can be­gin sud­denly. They might arise from an ear in­fec­tion, a head in­jury or cer­tain med­i­ca­tions. Low blood pres­sure can lead to dizzi­ness when you stand up quickly. Dis­or­ders re­lated to vi­sion, mus­cles, bones or joints can also con­trib­ute to bal­ance prob­lems.

“As Amer­ica gets older, many peo­ple with im­bal­ance have a col­lec­tion of th­ese prob­lems,” says Dr. Gor­don Hughes, NIH clin­i­cal tri­als di­rec­tor for hear­ing and

bal­ance. “They might have ag­ing of the ear, ag­ing of vi­sion, cataracts, mus­cle weak­ness from los­ing some mus­cle mass or arthri­tis in the hips, plus other prob­lems like di­a­betes.” Re­searchers have iden­ti­fied more than a dozen dif­fer­ent bal­ance dis­or­ders. The most com­mon is a sud­den, of­ten harm­less burst of vertigo that might arise with an abrupt change in the po­si­tion of the head, like when you bend over to tie your shoes. Tech­ni­cally known as be­nign parox­ys­mal po­si­tional vertigo (BPPV), this con­di­tion can re­sult from a head in­jury or sim­ply from get­ting older. BPPV some­times oc­curs when tiny cal­cium crys­tals in the in­ner ear be­come dis­placed. In that case, your doc­tor can treat BPPV by care­fully mov­ing the head and body to re­po­si­tion th­ese par­ti­cles. An NIH-sup­ported clin­i­cal trial showed that this treat­ment works well for BPPV. Another com­mon bal­ance dis­or­der is known as Ménière’s disease. It can de­velop at any age, but most of­ten strikes adults be­tween 40 and 60 years of age. Symp­toms in­clude in­tense vertigo, hear­ing loss, nau­sea, tin­ni­tus (a ring­ing or buzzing in the ear) and a feel­ing of full­ness in the ear. Ménière’s disease usu­ally af­fects only one ear. Some peo­ple with Ménière’s disease have sin­gle at­tacks of dizzi­ness sep­a­rated by long pe­ri­ods of time. Oth­ers may ex­pe­ri­ence many at­tacks closer to­gether over a num­ber of days. Some af­fected peo­ple have vertigo so ex­treme that they lose their bal­ance and fall. Th­ese episodes are called “drop at­tacks.”

An at­tack of Ménière’s symp­toms, while not life- threat­en­ing, can feel com­pletely over­whelm­ing. The symp­toms arise be­cause of a change in fluid vol­ume within the in­ner ear. But its un­der­ly­ing cause re­mains un­known. Sci­en­tists es­ti­mate that 6 in 10 peo­ple ei­ther get bet­ter on their own or can con­trol their vertigo with diet, drugs or de­vices. In se­vere cases, sur­gi­cal ther­a­pies can end the dizzi­ness but might af­fect hear­ing. NIH-funded re­searchers at the Univer­sity of Wash­ing­ton are now ex­plor­ing a new treat­ment op­tion to stop a Ménière’s at­tack. An im­plant be­hind the ear is de­signed to con­trol ab­nor­mal elec­tri­cal ac­tiv­ity in the nerve that sends bal­ance in­for­ma­tion to the brain, bring­ing the sen­sa­tion of spin­ning to a halt. The de­vice is now be­ing tested in clin­i­cal tri­als. If you think you may have a bal­ance dis­or­der, talk with your health care provider. Your doc­tor can as­sess whether your symp­toms might be caused by a se­ri­ous dis­or­der, such as a heart or blood con­di­tion. If an in­ner ear bal­ance dis­or­der is likely, you may be re­ferred to a spe­cial­ist such as an oto­laryn­gol­o­gist, a doc­tor with ex­per­tise in the ear, nose and throat. You might re­ceive a hear­ing test, a bal­ance test and pos­si­bly an imaging study of the brain. Work with your doc­tor to fig­ure out how to cope with your dizzi­ness on a daily ba­sis and re­duce your risk of in­jury. For ex­am­ple, wear low-heeled shoes or walk­ing shoes out­doors. You might de­cide to try us­ing a cane or walker. Safe, se­cure handrails in stair­wells and grip han­dles in bath­rooms can help make your home safer. Driv­ing a car may be es­pe­cially haz­ardous, so ask your doc­tor if it’s safe for you to drive. A spe­cial­ized re­ha­bil­i­ta­tion ther­a­pist can give you a set of head, body and eye ex­er­cises to help re­duce dizzi­ness and nau­sea. Mean­while, re­searchers con­tinue to work to de­velop new, more ef­fec­tive ap­proaches. In one ex­per­i­men­tal re­ha­bil­i­ta­tion strat­egy, now in clin­i­cal tri­als, sci­en­tists have cre­ated a “vir­tual re­al­ity” gro­cery store. It al­lows peo­ple with bal­ance dis­or­ders to walk safely on a tread­mill through com­puter-gen­er­ated store aisles. While hold­ing onto a gro­cery cart, they can look up and down, turn their heads and reach for items on vir­tual shelves. By do­ing this, they safely learn how to nav­i­gate an en­vi­ron­ment that can be chal­leng­ing for some­one with a bal­ance prob­lem. “The key for peo­ple look­ing for treat­ment is to go to the best team of clin­i­cal ex­perts that they can gain ac­cess to,” says Dr. Sklare. “It’s very im­por­tant to get that level of as­sess­ment.” Source: NIH News in Health, Au­gust 2012, pub­lished by the Na­tional In­sti­tutes of Health and the Depart­ment of Health and Hu­man Ser­vices. For more in­for­ma­tion go to www.news­in­health.nih.gov

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