The balance system involves cues from the visual system, vestibular system, and proprioceptive system. A disturbance in any of these can result in balance issues, and your audiologist will exam you to see if the vestibular system is causing your symptoms.
A disorder in the vestibular system and its interconnections with the brain can cause vertigo, imbalance, or dizziness. A disruption in your vestibular system can have serious side effects such as spatial disorientation, blurring of vision, and can cause falls.
The vestibular system can be affected by any recent head trauma, syndromes, or disease. A vestibular disorder can develop suddenly or gradually and can occur at any age.
A patient with non-vestibular-related balance issues may have lightheadedness symptoms, feeling like they are “floating” or veering to one side. Non-vestibular related dizziness can be caused by:
- Motion sickness
- New medication or dosage effects
- Blood pressure
- Stroke or heart disease
- Neurologic conditions
- Low blood sugar, low iron levels
Most of these inconvenient issues can be rectified by your local doctor. Still, if you find yourself suddenly losing your balance or being unable to control your balance for an extended period of time, it could be the cause of something far more serious and is worth mentioning to your doctor.
What are different vestibular pathologies?
BPPV- Benign Paroxysmal Positional Vertigo
BPPV is a mechanical issue in the inner ear. It occurs when otoconia (“crystals”) migrate into one of the semicircular canals from the utricle.
The otoconia affect the normal movement of fluid inside the semicircular canal and cause a false signal to be sent to the brain that causes vertigo with movement.
Symptoms of BPPV typically are recurrent brief, less than 1 minute, episodes of vertigo. Changes in head or body positions provoke vertigos.
Treatment for BPPV includes canalith repositioning maneuvers. These maneuvers help to remove the otoconia from the semicircular canal and bring them back to the utricle.
Labyrinthitis & Vestibular Neuritis
Labyrinthitis and Vestibular Neuritis typically occur in one ear and is related to an infection that causes inflammation in the inner ear or vestibular nerve.
This can be caused by a virus such as influenza, herpes, measles, mumps, or polio but can also happen spontaneously. Labyrinthitis affects both hearing and vestibular function, while Neuritis only affects vestibular function.
Presentation includes a sudden onset of vertigo that can last up to 20 minutes, and symptoms will improve over the following weeks.
Treatment can include temporary medications to suppress vertigo, steroids, or IV fluids for dehydration.
Lingering balance issues can occur, and if so, exercise is recommended and physical therapy to reinforce neural compensation.
Meniere’s disease is a rare disease with no known cause, although it is thought to be due to increased endolymphatic fluid or pressure increase.
Meniere’s typically affects one ear when it begins, and over time there is a chance it can involve both ears.
Symptoms of Meniere’s include episodic vertigo that lasts at a minimum of 20 minutes but can occur for hours, nausea, tinnitus that is increased during an attack, fluctuating hearing loss in the affected ear, and aural fullness.
The attacks of Meniere’s disease are typically spontaneous but can be triggered by allergies, increased salt intake, or changes in pressure.
Treatment for Meniere’s varies but can include:
- Avoiding alcohol, caffeine, and sugar
- Having a low-salt diet
- Temporary vestibular suppressants
- Allergy management
- Stress reduction
- Surgery for chronic conditions
Migraines are a neurological disorder and are more common in females. About 20-30% of patients with migraines report vertigo.
Symptoms of a migraine headache may include:
- Severe localized throbbing in the head
- Nausea and vomiting
- Increased sensitivity to light and sound
- Head fullness
- Flashing lights or blind spots
The associated vestibular symptoms may include:
- True vertigo
- Spatial disorientation
Treatment for a vestibular migraine may involve medications, vestibular rehabilitation, and lifestyle modifications.
An acoustic neuroma is a benign tumor on the 8th nerve and has a low incidence affecting approximately 3000 individuals each year in the United States. Acoustic neuromas typically occur in one ear but can rarely occur in both ears.
Symptoms of an acoustic neuroma include:
- Hearing loss
- Facial nerve dysfunction
- Facial numbness
Treatment options for an acoustic neuroma may include surgery, radiotherapy, or monitoring only.
What Should I Do Now?
If you’re concerned about your balance or would like professional advice on anything that you have read in this article, then our team of experts is here to help.