Balance Disorder Center

Balance Resources:
	Balance Services
	Vertigo & Dizziness?
	What is BPPV?
	Balance Testing?

Balance Services & Treatments

Caloric Vestibular test (binaural, bithermal) Canalith repositioning (CRP) Dix Hallpike Maneuver Oscillating tracking test Positional Nystagmus test, minimum of 4 Positions, with recording Spontaneous Nystagmus test, including Gaze and fixation nystagmus, with recording Videonystagmography (VNG)

Vertigo/Dizziness

Causes of Dizziness, Vertigo, and Imbalance

A large percentage of the adult population reports episodes of dizziness or vertigo to a physician during their lifetime. Many of these cases involve vestibular (inner ear) disorders. Other cases of dizziness are due to problems unrelated to the inner ear, such as cardiovascular, neurological, or psychological disorders.

Dizziness Caused by Vestibular Disorders

The vestibular organs of the inner ear provide the brain with information about changes in head movement. If the vestibular system is not functioning properly, dizziness, vertigo, imbalance, spatial disorientation, and other symptoms can result.

Vestibular-system distress can be caused by a variety of influences, including viral infections of the labyrinth (labyrinthitis) or the vestibular nerve (vestibular neuronitis). Bacterial infection of either the middle ear (otitis media) or the brain coverings (meningitis) may spread to the inner ear. Allergies can cause changes in the inner ear fluids or middle ear pressure because of swelling of the Eustachian tube and production of fluid in the middle ear.

Head trauma is a common cause of inner ear damage in people under age 50. A blow to the head or a "whiplash" injury can result in, for example, perilymph fistula or benign paroxysmal positional vertigo (BPPV). Vestibular-system dysfunction may appear immediately following head trauma or after a delay of days, weeks, or months.

Vestibular disorders can also occur from exposure to ototoxins (drugs or chemicals that are harmful to the inner ear or the vestibulo-cochlear nerve). Degeneration of the hair cells in the inner ear is also thought to occur with aging and can result in dizziness and vertigo as well as hearing loss. A benign tumor known as an acoustic neuroma can grow on the vestibulo-cochlear nerve. In many cases of vestibular disorders, including Meniere's disease and other forms of endolymphatic hydrops, the underlying or original cause cannot be determined.

Other conditions that may affect vestibular function include migraine, mal de debarquement (a sensation of rocking that persists after a cruise or other travel), autoimmune inner ear disease, cervical (neck) problems, vascular compression of the vestibular nerve, superior canal dehiscence, cholesteatoma, enlarged vestibular aqueduct, and others. From VEDA publication B-1, Balancing Act, 2nd edition

Dizziness from Non-Vestibular Causes

Dizziness is the second most common complaint heard in doctors' offices (after lower back pain). Dizziness has many causes other than inner ear dysfunction.

Visual disturbances can result in lightheadedness or dizziness. Some people feel dizzy while adjusting to bifocals or a new eyeglass prescription, or from reduced vision due to cataracts.

Hyperventilation can cause temporary dizziness. During rapid breathing, more carbon dioxide than normal is expelled and the level of carbon dioxide in the blood falls, which in turn affects the function of brain cells.

Decreased blood flow to the brain or brain stem can cause dizziness, because insufficient oxygen is reaching the cells. Conditions that can reduce blood flow to the brain include orthostatic hypotension (low blood pressure upon suddenly rising from a lying or sitting position), dehydration, vasovagal syndrome (a nervous-system response that causes sudden loss of muscle tone in peripheral blood vessels), arteriosclerosis (hardening or narrowing of blood vessels), and osteoarthritis (a joint disease that can narrow the openings in the neck vertebrae through which blood vessels flow).

Nervous-system disorders such as peripheral neuropathies (diminished nerve function in the legs or feet) can cause unsteadiness. A tumor may affect the brain stem, the cerebellum (the coordination center of the brain), or the part of the cerebral cortex that controls voluntary muscle movements.

Even stress, tension, or fatigue may cause dizziness. Under these conditions, the brain stem functions less efficiently, resulting in some loss of automatic reflex control of balance. This leads to elevated levels of activity for the cerebral cortex, as conscious energy is used to help maintain balance by controlling voluntary muscle movements. Lightheadedness and unsteadiness can result from VEDA publication B-1, Balancing Act, 2nd edition.

Grade-school children from Toledo, Ohio, created the impressions of dizziness shown below. The students received no help with their work except art materials and a discussion about how it felt to be dizzy. All of these works were entered in the 1997-98 VEDA art contest for children.

 

What is BPPV?

BPPV (Benign Paroxysmal Positional Vertigo) is a common cause of dizziness caused by debris, which has collected in the inner ear. Patients usually report brief episodes of vertigo brought on by lying down, rolling over in bed, or tilting their heads back. The vertigo (spinning sensation) may occur frequently for weeks at a time, disappear for months, and then reappear with no warning. It is a mechanical dysfunction in the inner ear and is relatively easy to diagnose and treat. It does not respond to medication but is effectively treated with canalith repositioning procedures.

For more information on BPPV

Balance Testing

At Coastal Ear Nose and Throat we use Videonystagmography (VNG) technologies for testing inner ear and central motor functions. VNG testing is considered the new standard for testing inner ear functions over Electronystagmography (ENG), because VNG measures the movements of the eyes directly through infrared cameras, instead of measuring the mastoid muscles around the eyes with electrodes like the previous ENG version. VNG testing is more accurate, more consistent, and more comfortable for the patient. By having the patient more comfortable and relaxed, consistent and accurate test results are more easily achieved.

VNG testing is used to determine if a vestibular (inner ear) disease may be causing a balance or dizziness problem, and is one of the only tests available today that can decipher between a unilateral (one ear) and bilateral (both ears) vestibular loss. VNG testing is a series of tests designed to document a persons ability to follow visual objects with their eyes and how well the eyes respond to information from the vestibular system.

This test also addresses the functionality of each ear and if a vestibular deficit may be the cause of a dizziness or balance problem. To monitor the movements of the eyes, infrared goggles are placed around the eyes to record eye movements during testing. VNG testing is non-invasive, and only minor discomfort is felt by the patients during testing as a result of wearing goggles. Appointments usually last about 1.5 hours, and testing is covered by all insurances.

There are 3 main parts to the VNG test:

1. Occular Mobility
   You will be asked to have your eyes follow objects that jump from place to place, stand still, or move smoothly. The technician will be looking for any slowness or inaccuracies in your ability to follow visual targets. This may indicate a central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.
2. Positional Nystagmus
   The technician will move your head and body into various positions to make sure that there are no inappropriate eye movements (nystagmus), when your head is in different positions. This test is looking at your inner ear system and the condition of the endolymph fluid in your semi-circular canals. The technician is verifying that small calcium carbonate particles called otoconia are not suspended in the fluid and causing a disturbance to the flow of the fluid.
3. Caloric Testing
   The technician will stimulate both of your inner ears (one at a time) with warm and then cold air. They will be monitoring the movements of your eyes using goggles to make sure that both of your ears can sense this stimulation. This test will confirm that your vestibular system for each ear is working and responding to stimulation. This test in the only test available that can decipher between a unilateral and bilateral loss.

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