Dizziness, unsteadiness, spinning, faintness, light-headedness, imbalance, vertigo, veering and nausea are just some of the terms described by individuals with balance problems. Ask a group of people if they have experienced these symptoms before and most will say they have. Usually these symptoms are an isolated occurrence or very brief in length. However, in some individuals these episodes can be severe and/or frequent. This is when a vestibular (balance) disorder is considered.
How do I normally keep my balance?
The balance system is next to your inner ear/cochlea on each side. It is made up of fluid-filled chambers and canals containing nerve endings that transmit information about the position of the head to the brain. The correct functioning of this system is critical to the brain’s ability to maintain control of the body’s motor functions of standing, walking etc. If you have ever wondered why you can see clearly when walking or running, it is because the system is also responsible for controlling reflexive eye movements. In fact, the movement of the eyes helps us a lot in the clinic when examining balance disorders.
What balance disorders are most common among seniors?
Age-related balance dysfunction
As we age, the chance of experiencing balance problems increases. The gradual loss of vestibular function is likely due to a reduction in the number of nerve cells and/or decreased blood flow to the balance system. This type of age-related vestibular dysfunction might be observed as having difficulty standing or walking, particularly in the dark or on uneven surfaces. Although it might not seem serious at the time, age-related balance disorders are one reason older people fall and injure themselves.
Benign Paroxysmal Positional Vertigo (BPPV)
Those with BPPV experience an intense feeling of vertigo or dizziness when changing head position. It is commonly experienced when getting out of or rolling in bed or tipping the head back to look up, such as when reaching an item from a shelf. BPPV is caused by the displacement of small calcium crystals called otoconia within the canals of the vestibular system. When the head moves, the loose otoconia shift and false information is sent along the nerve and to the brain.
Diagnostic testing involving examining eye-movement can help diagnose BPPV. Specific positional manoeuvres performed by a specialised clinician can be successful in repositioning the displaced otoconia and restoring balance.
Meniere’s disease describes a set of symptoms including spontaneous ‘attacks’ of vertigo (spinning), a sense of ear fullness, ringing or roaring tinnitus and fluctuating hearing loss commonly affecting low tones. Episodes can last up to 4 hours before recovery, however permanent hearing loss or reduced vestibular function can result. Those in their 40s and 50s are more likely to develop Meniere’s disease than those in other age groups, however it can affect all ages.
Although the cause of Meniere’s disease is unknown, it is likely attributed to excess endolymph, a potassium rich fluid in the inner ear. Pressure from the excess fluid disrupts the normal functioning of the vestibular and auditory system.
There are various treatment options for managing Meniere’s disease and the stage of the disease process will dictate the course of action. A low-salt diet is often advised as excess sodium intake can exacerbate the vertigo symptoms.
Vestibular neuritis is caused by a swelling of the vestibular branch of the vestibulocochlear nerve; the nerve responsible for carrying vestibular and auditory information to the brain. However, Labyrinthitis affects both the vestibular and auditory sections of the nerve. Symptoms for both are severe vertigo and dizziness for a couple of days, easing over the next few weeks. Tinnitus and hearing loss can accompany labyrinthitis as it involves the cochlear branch of the nerve.
Both conditions are likely to be caused by a viral infection either isolated to the inner ear or elsewhere in the body.
What should I do if I think I have a balance disorder?
The first step is to discuss your symptoms with your family doctor. He/she may refer you for further testing at a clinic specialising in balance disorders. At the clinic several diagnostic vestibular tests will be performed to help isolate the described symptoms to a particular cause. This, in turn, will help the specialist to decide the appropriate course of treatment or to arrange imaging or further testing.
The Audiology Department at Royal Perth Hospital provides services including general audiological assessments, vestibular/balance testing, diagnostic hearing testing and a comprehensive auditory implant program.
There are myriad hearing solutions for the various types of hearing loss. These could include hearing aids, but when a hearing aid is no longer enough, there are implantable solutions to consider such as a Cochlear™ Implant or a Cochlear™ Baha.
A Cochlear Implant is an electronic medical device that replaces the function of the damaged inner ear. It can provide a long-term solution for people with moderate to profound hearing loss in one or both ears. Rather than making sounds louder, Cochlear Implants do the work of the damaged parts of the inner ear (cochlea) to provide sound signals to the brain.
A Cochlear Baha is a bone conduction implant system and is suitable for people with single-sided deafness, conductive hearing losses or those who have mixed hearing losses that prevent them from using regular hearing aids because of ear infections and irritation. The Baha picks up sounds from the hearing loss side and transfers them to the good ear.
By Chris Broadbent