Balance disorders

What is a balance disorder?

A balance disorder is a condition that makes you feel giddy or dizzy, as if you are moving, spinning, or fainting, floating, even though you are standing still or lying down and feeling as if swaying or falling while walking.

Balance disorder can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.

Dizziness is usually because systemic conditions like Anaemia, hypotension and brain disorders like stroke etc whereas giddiness is usually because of labyrinthine problems or cerebellar lesion.

Labyrinth, a sensory organ in inner ear is responsible for a] balance [semicircular canals and otolithic organs]  b] hearing [snail-shaped organ called the cochlea].

 The medical term for all of the parts of the inner ear involved with balance is the Vestibular system.

How does the vestibular system work?

Vestibular system works with other sensorimotor systems in the body, such as our visual system (eyes) and skeletal system (bones and joints), to check and maintain the position of our body at rest or in motion. It also helps us maintain a steady focus on objects even though the position of our body changes. The vestibular system does this by detecting mechanical forces, including gravity, that act upon our vestibular organs when we move. Two sections of the labyrinth help us accomplish these tasks: the semicircular canals and the otolithic organs.

Our visual system works with our vestibular system to keep objects from blurring when our head moves and to keep us aware of our position when we walk or when we ride in a vehicle. Sensory receptors in our joints and muscles also help us maintain our balance when we stand still or walk. The brain receives, interprets, and processes the information from these systems to control our balance.

What are the symptoms and side effects of a balance disorder?

If your balance is impaired, you may feel as if the room is spinning. You may stagger when you try to walk or teeter or fall when you try to stand up. Some of the symptoms you might experience are:

• Giddiness (a spinning sensation)
• Falling or feeling as if you are going to fall
•  Lightheadedness, faintness, or a floating sensation
• Blurred vision
•  Confusion or disorientation

Other symptoms are nausea and vomiting. Side effects are changes in heart rate and blood pressure, and fear, anxiety, or panic. Some people also feel tired, depressed, or unable to concentrate. Reduced quality of life, fear to move outside, unable to drive vehicles, injuries from actual falls. 

 

 

What causes a balance disorder?

A balance disorder may be caused by labyrinthine dysfunction caused by viral or bacterial infection, a head injury, or blood circulation disorders that affect the inner ear or brain. Many people experience problems with their sense of balance as they get older. Balance problems and dizziness also can result from taking certain medications.

In addition, problems in the visual and skeletal systems and the nervous and circulatory systems can be the source of some posture and balance problems. A circulatory system disorder, such as low blood pressure, can lead to a feeling of dizziness when we suddenly stand up. Problems in the skeletal or visual systems, such as arthritis or eye muscle imbalance, also may cause balance problems. However, many balance disorders can begin all of a sudden and with no obvious cause.

 

What are some types of balance disorders?

 Some of the most common vestibular disoreders are:

Benign paroxysmal positional vertigo (BPPV) or positional vertigo is a brief, intense episode of giddiness that occurs because of a specific change in the position of the head. If you have BPPV, you might feel as if you're spinning when you look for an object on a high or low shelf or turn your head to look over your shoulder . You also may experience BPPV when you roll over in bed. BPPV is caused when otoconia tumble from the utricle into one of the semicircular canals and stimulate hair cells , the sensory end organs of balance.

Labyrinthitis is an infection or inflammation of the inner ear that causes dizziness and loss of balance. It frequently is associated with an upper respiratory infection such as the flu.

Ménière's disease is associated with a change in fluid volume within parts of the labyrinth. Ménière's disease causes episodes of vertigo, irregular hearing loss, tinnitus (a ringing or buzzing in ear), and a feeling of fullness in the ear. The cause of this disease is unknown.

Vestibular neuronitis is an inflammation of the vestibular nerve and may be caused by a virus. Its primary symptom is vertigo.

Motion sickness is condition that causes giddiness during vehicular journeys, many times it is associated with nausea and vomiting

Mal de debarquement syndrome (MdDS) is a balance disorder in which you feel as if you're continuously rocking or bobbing. It generally happens after an ocean cruise or other sea travel. Usually, the symptoms will go away in a matter of hours or days after you reach land. However, severe cases can last months or even years.

How is a balance disorder diagnosed?

Diagnosis of a balance disorder is difficult. There are many potential causes - including medical conditions and medications. Hence it is a team work wherein many different specialists will be involved like Physician, ENT surgeon, Neurologist, Eye specialist, physiotherapist etc depending upon the nature of illness and system involved.

Physicians will primarily check whether the person has got systemic illness like Blood pressure, anemia like blood problems, heart, kidney related problems.

To help evaluate a balance problem, your doctor may suggest you to consult ENT specialist. An ENT specialist may request tests to assess the cause and extent of the balance problem depending on your symptoms and health status.

A neurologist will be involved in the treatment if unconscious or disoriented pts with difficulty in walking,  swallowing , phonation  and double vision suggesting brain related problems.

Collectively you might be requested to go for hearing examination, an electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of your head and brain [CT and MRI], variable blood tests. 

How is a balance disorder treated?

Priority is given to diagnose the condition and simultaneously treating the vertigo by starting anti vertigo, anti emetic drugs along with antibiotic, antiviral, steroid , multivitamins with IV fluids for correcting dehydration.

Your doctor also may describe ways for you to handle daily activities that increase the risk of falling and injury, such as driving, walking up or down stairs, and using the bathroom. If you have BPPV, your doctor might prescribe a series of simple movements, called the Epley maneuver, to help dislodge the otoconia from the semicircular canal.

If you are diagnosed with Ménière's disease, your doctor may recommend along with medication , changes in your diet,  some lifestyle management, quitting smoking .  In serious cases transtympanic gentamicin injection therapy will be suggested.

Some people with a balance disorder may not be able to fully relieve their dizziness and will have to develop ways to cope with it on a daily basis. A physiotherapist can help by developing an individualized treatment plan that combines head, body, and eye exercises to decrease dizziness and nausea.

To reduce your risk of injury from dizziness, avoid walking in the dark. You also should wear low-heeled shoes or walking shoes outdoors and use a cane or walker if necessary. If you have handrails in the home, inspect them periodically to make sure they are safe and secure. Modifications to bathroom fixtures can make them safer. Conditions at work may need to be modified or restricted, at least temporarily. Driving a car may be especially hazardous. Ask your doctor's opinion about whether it's safe for you to drive.

How do I know if I have a balance disorder?

Every individual suffers from dizziness or giddiness at one or the other point in life. To help you decide whether or not you should seek medical help for a dizzy spell, ask yourself the following questions. If you answer “yes” to any of these questions, talk to your doctor.

• Do I feel unsteady?
• Do I feel as if the room is spinning around me?
• Do I feel as if I'm moving when I know I'm sitting or standing still?
• Do I lose my balance and fall?
• Do I feel as if I'm falling?
• Do I feel “lightheaded” or as if I might faint?
• Do I have blurred vision?
• Do I ever feel disoriented, such as losing my sense of time or where I am?

 

 

Balance challenge test

      This is a simple test performed in three steps. The person is supposed to stand in open space with a chair or wall to support.

Step 1 : stand with both legs close to each other and count till 10.

Step 2 : stand with one leg in front of the other in tandem and count slowly till 10

Step 3 Stand on one step and count up to 10

If you are not able to keep the balance during any step means you are suffering from imbalance, stop the test and consult a doctor.

  

How can I help my doctor make a diagnosis?

You can help your doctor make a diagnosis and determine a treatment plan by answering the questions below. Be prepared to discuss this information during your appointment.

1. Explain your dizziness in a simplest way

2. How often do I feel dizzy or have trouble keeping my balance?

3. Have I ever fallen? (When did I fall?)

• Under what conditions did I fall?
• How often have I fallen?

4. These are the medicines I take:

• Include prescription medications and over-the-counter medicine, such as  , antihistamines, or sleeping pills. How much (milligrams) and how often (times) per day….., the condition I take this medicine for is ….

Future steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.