Vertigo, dizziness, unsteadiness, difficulty judging distance or space can impact an individual’s balance and increase their risk of falling. A fall is always a bit scary regardless of why it may have occurred, whether it’s due to a missed step, broken sidewalk or absentmindedness. But a fall may mean much more than a case of clumsiness. The fall may be a signal that something is throwing off their balance, and they could possibly be suffering from a vestibular disorder. According to John Keeley, Clinical Education Specialist for the Shore Balance Center and Sleep Center in Somers Point, NJ, “Vestibular disorders and falls often lead to the lessening of mobility, due to fear of falling or an injury due to a fall. This can also accelerate other health complications and comorbidities.”
There are three components that impact balance: the vestibular system that is located in the inner ear; eyes; and movement and spatial orientation. Patients who have complaints of some type of balance problems might be suffering from vertigo which is a spinning sensation. They might complain of dizziness and have feelings of being lightheaded or even feeling like they will faint. Others will just feel unsteady which is referred to as disequilibrium. For others, it is changes in their hearing or problems concentrating that are lending to the problem with their balance, according to Keeley.
Have you Ever…?
Used a cane or walker? Do you currently take more than two prescriptions, have frequent headaches or migraines, had a stroke or a concussion, experienced blurred or double vision or suffered neck or head trauma? Have you ever had ringing or buzzing in your ears? Have you experienced an increased sensitivity to light? All of these symptoms could put a person at an increased risk for falls, according to Keeley, and signal that something might be amiss in the vestibular system affecting balance.
Our vestibular system is a sensory system inside the ear that is responsible for providing information to the brain about motion, head position, and spatial orientation. It is essential for normal movement and equilibrium. It works with motor functions that help us maintain balance as well as posture and it keeps us from stumbling, tumbling and getting hurt.
The vestibular system sits inside the inner ear and is made up of the vestibular labyrinth. It includes semicircular canals that are situated in a plane where the head can rotate. The head moving forward and back is referred to as linear acceleration while the tilting, nodding and side to side movement of the head is rotational acceleration.
Those semicircular canals in the inner ear are filled with endolymph fluid. When the head is rotated, the endolymph rolls through the canal that corresponds with the plane of movement and sends a message to the brain. It uses the tiny otolith organs inside the ear to detect movement using the utricle for horizontal movement and the saccule for vertical movement.
The vestibular system uses this information about movement gained through the semicircular canals and otolith organs to maintain balance, stability, and posture through reflex actions. This involves the connection between the vestibular system and the muscles of the eyes that, for example, allows our gaze to remain fixed on a particular point even when we move our heads. Disruption of the vestibular system, whether due to an injury or illness or due a temporary state like alcohol intoxication, can involve symptoms like vertigo, loss of balance, and nausea and can range in severity from mild to incapacitating.
Keeley said balance issues are not limited to those over 65, adding that more than half of the population will experience some kind of balance issue, dizziness or vertigo at some time in their lives. “Our mission is to help patients decrease their fall risk and alleviate their dizzy symptoms and help them regain their ability to perform daily activities.”
Types of Vestibular Disorders
There are two types of vestibular disorders: peripheral vestibular and central vestibular disorders. According to Keeley, peripheral disorders affect the inner ears. The central vestibular disorders affect the parts of the brain that process balance and spatial information.
Vertigo is a very specific type of dizziness that most of us have experienced at least once in our lives, even if only briefly. Vertigo is an intense feeling of motion or movement, like you are being dropped into a world that is spinning around you while you are motionless. Keeley said most people experience vertigo in short bursts and rather infrequently. However, for some people, it can last for hours or even days. In the more serious cases, people may experience nausea, vomiting, or an increased heart rate accompanying the unpleasant sensation.
There are two types of vertigo: central vertigo, which is caused by damage to the nervous system, and vertical vertigo, which is caused by issues in the inner ear. Vertical vertigo is far more common.
The word vertigo comes from the Latin word Verto which is a whirling or spinning movement. In medical terms, vertigo is the sensation that everything around you is spinning when it is not. Benign positional vertigo, the most common form of vertigo, is not dangerous, but it can be unpleasant. Keeley said most people feeling the spinning symptoms should speak with their primary care physician to find out what is causing the disturbance in their inner ear.
Falls and the Emergency Department
According to the Centers for Disease Control and Prevention, over three million older adults in this country will find themselves in the emergency department as a result of a fall. Statistically, more than 800,000 of those fall victims will need to be admitted for treatment. They are most often admitted due to a head injury or a hip fracture. The hip fracture can rob the older adult of their independence.
Keeley explained that falls coming into the emergency department are quite concerning. While the bump on the head or broken hip might be what brought the patient into the emergency department, the balance issue could be at the core. At Shore Medical Center, patients leaving the emergency department are given a falls analysis to take upon discharge and to discuss the next steps with their primary care physician.
The Balance Center has recently created a quick assessment/quiz to determine if the patient is a good candidate for balance testing and if they need to treat what might be impacting their vestibular system. The assessment asks about a perception of movement or spinning objects, a sensation of lightheadedness, dizziness when turning over in bed or turning your head quickly, double vision, sudden hearing loss or if you had ever suffered a stroke. Keeley said patients who are experiencing any of the above symptoms should speak with their health care provider and ask about balance testing. He added that all patients assessed at the Balance Center would need a prescription from a physician.
Testing and Treatment for Vestibular Disorders
The most common test for vestibular disorder is the Videonystagmogram or VNG. The testing is used to determine if a vestibular or inner ear disorder may be causing a balance or dizziness problem, which can determine which ear or if both ears are involved. Keeley said a VNG will test the strength of the inner ear as well as the coordination of eye movements. The test takes about up to 90 minutes to complete.
The possible treatments for a vestibular disorder include:
- Vestibular Therapy - A rehabilitation specialist will teach you how to cope with dizziness as part of your daily life.
- Physical Therapy - Includes a specialized series of movements of your head and chest to eliminate symptoms.
- Intervention with a Specialist - Depending on the outcome of the vestibular testing, it might warrant an intervention with an ENT/otolaryngologist, neurologist or neurotologist.
- Lifestyle Changes – Changes in diet and activity might help ease symptoms
- Antibiotic or Antifungal Treatments – These may be in order if the dizziness or vertigo is caused by and ear infection.
- Surgery – This would be a last resort when therapy and medicine are unable to control symptoms.
Talk with your health care professional about your balance symptoms and for a recommendation for balance testing and treatment. To speak with a Balance Center specialist or to request information call 800-632-6807.