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Balance Disorders

Alfred J. Mauriello, MD, Otolaryngologist
The Chester County Hospital

Published: July 17, 2009

Difficulties with balance result in a person feeling unsteady. Because there are so many potential causes, it is helpful to characterize the symptoms, such as a sensation of movement, spinning, wooziness, lightheadedness or faintness. Dizziness described as feeling faint or lightheaded is frequently caused by a vascular disorder (blood flow problem). The side effects of some medications, metabolic disorders, and neurologic problems may also cause these symptoms.

Symptoms such as spinning (vertigo), any sense of abnormal movement such as rocking, staggering, or falling, are more frequently caused by a disorder of the inner ear mechanism of balance (the vestibular system or labyrinth). This organ consists of three fluid-filled semicircular canals each of which has a different orientation (position). These respond to movements of the head to the side or in an up-and-down direction. Two other parts of the vestibular system (the utricle and saccule) detect movement in a linear fashion, such as acceleration.

Sensory hair cells covered with very small calcium stones (otoconia) are found in the inner ear. They can become displaced by changes in position and gravity causing the hair cells to bend. This, in turn, results in nerve impulses that interact with input from our eyes as well as our musculoskeletal system by way of pathways in the nervous system and brain providing us with a sense of our orientation in space. These systems are extremely important in maintaining balance.

The symptoms of balance disorders originating in the inner ear not only include vertigo or a sensation of movement, but also include blurring of vision, nausea, vomiting and a sense of disorientation. The causes of this include viral or bacterial infections, diminished blood flow to the inner ear, head trauma, the effects of aging, certain medications, changes in the fluid pressure of the inner ear (either a leak or an increase in pressure), and tumors of the inner ear.

The diagnosis and treatment of balance disorders are complex. A person experiencing symptoms should see their physician for an evaluation. After the initial history and physical examination, the primary physician may request the opinion of an otolaryngologist (ear, nose and throat specialist - ENT), cardiologist, neurologist or endocrinologist. The vestibular system of the inner ear is the primary cause of vertigo, but still accounts for less than 50% of all causes.

The otolaryngologist will perform a thorough history and physical examination. Additional diagnostic studies frequently performed include hearing testing, tests of the inner ear mechanisms (VNG, ABR, VEMP and posturography), and imaging studies of the inner ear and brain. Each of these studies has specific indications and provides discrete information on inner ear functions.

If this evaluation indicates that the problem is vestibular in origin, the otolaryngologist will direct medical, surgical and other treatment options that are available. This may include treatment of a contributing disease (such as an ear infection); head-positioning maneuvers to reposition displaced otoconia in the inner ear; vestibular rehabilitation (balance retraining); dietary and medical treatment for increased fluid pressure of the inner ear; direct injection of medications into the middle ear; and/or surgery to decompress the inner ear, seal a leak, or remove a small tumor.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 8/19/2009