Yearly more than two million people visit a doctor for dizziness, and an untold number suffer from motion sickness. Although patients complain of similar symptoms, there are different treatments available. An otolaryngologists will explore the causes behind the balance discomfort by examining the ears, nose, and throat to make a diagnosis. Often times, cases of dizziness and motion sickness are mild and self-treatable disorders, but severe cases deserve medical attention.
Some people describe a balance problem by saying they feel dizzy, lightheaded, unsteady, or giddy. This feeling of imbalance or disequilibrium is sometimes caused by an inner ear problem. Others describe their balance problem by using the word vertigo, which comes from the Latin verb "to turn". They often say that they or their surroundings are turning or spinning. Vertigo can also be triggered by problems in the inner ear.
Motion sickness is a common medical problem associated with travel. Some people experience nausea and even vomiting when riding in an airplane, automobile, boat, or amusement park ride. Motion sickness is usually just a minor annoyance and does not signify any serious medical illness, but some travelers are incapacitated by it. A few even suffer symptoms for a few days after the trip.
Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Researchers in space and aeronautical medicine call this sense spatial orientation, because it tells the brain where the body is "in space:" what direction it is pointing, what direction it is moving, and if it is turning or standing still.
Your sense of balance is maintained by a complex interaction of the following parts of the nervous system:
The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems. For example, suppose you are riding through a storm, and your airplane is being tossed about by air turbulence. But your eyes do not detect all this motion because all you see is the inside of the airplane. Then your brain receives messages that do not match with each other. You might become "air sick." Or, to use a true medical condition as an example, suppose you suffer inner ear damage on only one side from a head injury or an infection. The damaged inner ear does not send the same signals as the healthy ear. This gives conflicting signals to the brain about the sensation of rotation, and you could suffer a sense of spinning, vertigo, and nausea.
The doctor will ask you to describe your symptoms, whether it is light headedness or a sensation of motion, how long and how often the dizziness has troubled you, how long a dizzy episode lasts, and whether it is associated with hearing loss or nausea and vomiting. You might be asked to cite specific circumstances that induce a dizzy spell. You will also be questioned about your general health, medicines you are taking, head injuries, recent infections, etc.
The physician will examine your ears, nose, and throat and do tests of nerve and balance function. Because the inner ear controls both balance and hearing, disorders of balance often affect hearing and vice versa. Therefore, your physician might recommend hearing tests or audiograms. Depending on your diagnosis, the physician might order skull X rays, a CT or MRI scan of your head, or special tests of eye motion after warm or cold water is used to stimulate the inner ear (ENG - electronystagmography). In some cases, blood tests or a heart evaluation might be recommended.
Ménière’s disease, also called idiopathic endolymphatic hydrops, is a disorder of the inner ear. Although the cause is unknown, it probably results from an abnormality in the fluids of the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients. Ménière’s disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers.
The symptoms of Ménière’s disease may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning. Among them are:
From all the Ménière’s disease’s symptoms, vertigo is usually the most troublesome. It is commonly produced by disorders of the inner ear, but may also occur in central nervous system disorders. Vertigo may last for 20 minutes to two hours or longer. During attacks, patients are usually unable to perform activities normal to their work or home life. Sleepiness may follow for several hours, and the off-balance sensation may last for days.
The physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. You may be asked whether there is history of syphilis, mumps, or other serious infections in the past, inflammations of the eye, an autoimmune disorder or allergy, or ear surgery in the past. You may be asked questions about your general health, such as whether you have diabetes, high blood pressure, high blood cholesterol, thyroid, neurologic or emotional disorders. Tests may be ordered to look for these problems in certain cases.
When the history has been completed, diagnostic tests will check your hearing and balance functions. They may include:
Aside from lifestyle changes, your doctor may advice you to take a diuretic (water pill) to reduce the frequency of attacks. Anti-nausea and anti-vertigo medications may also be prescribed to provide temporary relief. However, a side-effect of the medications may be drowsiness.
Another medication that may be used is gentamicin. It is an antibiotic, commonly administered in the form of drops or injections, which causes a partial loss of balance function in the treated ear, controlling vertigo in about three fourths of cases and usually preserving hearing. Apart from a period of disequilibrium that can occur as the patient adjusts to the new level of balance, this treatment is usually very well tolerated. It is also significantly simpler and less invasive than other surgical treatments.
In addition, stress management counseling may be recommended, as stress tends to aggravate the symptoms of vertigo and tinnitus. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. Safety may require you to forego ladders, scaffolds, and swimming.
If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended:
Every year more than two million Americans fall and sustain serious injury, costing in excess of $3 billion dollars. Hidden costs include pain, disability, lawsuits, deterioration in general well-being, and the impact on other family members. Falls and the resulting injuries have become one of the elderly's most serious health issues. As our senior population continues to grow, falls and their consequences will increase in the future.
The accumulation of injuries throughout life change or damage the central nervous system (CNS) and the body as a whole, and our bodies deteriorate through inactivity. Vision diminishes with advancing age, and this directly affects the sensory systems involved with movement. The sensory cells in the ears’ balance system change, gradually decrease and cannot be replaced. The nerves which carry sensory information to the brain also deteriorate with age, and complex brain interconnections lose connecting fiber and nerve cells. The ability of nerve endings to generate the chemicals responsible for the transmission of information also seems to be affected by aging. This process accelerates after the age of 50.
Many diseases affect the CNS and sense organs. Hardening of the arteries (atherosclerosis) is probably the worst; it is accelerated by hypertension, smoking, and diabetes. Although it gradually increases during middle age, there is a point at which a slight additional decrease in blood flow causes serious vascular impairment such as stroke.
Head injuries, sometimes caused by falls, can damage the sense organs in the inner ears, or the brain itself. The worst disability occurs when both sense organs and CNS structures are damaged simultaneously. Physical activity is very important for recovery from injury to the sensory systems. The general debility of aging can negatively affect recovery if it results in a decreased level of activity. Central nervous system disorders, such as Alzheimer’s Disease, can severely affect higher nervous system function.
Diseases of the eyes, such as glaucoma and cataracts, decrease visual sensory function and are a common problem in old age. Injuries to the knees, hips, and back often do not completely heal, leaving some limitation of motion. Arthritis can cause permanent, crippling, nonreversible effects. Osteoporosis leads to bone weakness and increases the probability of serious injury from a fall, or might cause a spontaneous fracture and lead to a fall. Muscle strength gradually decreases with age. Joint tendons and ligaments lose their flexibility and limit motion. The combined ravages of bone and joint injury, arthritis, and inactivity can result in a body which cannot carry out motion commands initiated by the brain.
As many of the problems responsible for falling develop during early and middle age, initial efforts to prevent injuries must be aimed at younger age groups. Many of the changes in muscle, bone, and the central nervous system are not inevitable results of aging, but are brought on by inactive lifestyles and self-inflicted damage from smoking, poor diet, and lack of exercise.
Although hardening of the arteries is occasionally hereditary, in most cases it can be reduced by diets low in cholesterol and saturated fatty acids, as well as regular physical exercise. This stimulates the muscles as well as the cardiovascular system and could greatly reduce this problem. If there is a family history of hardening of the arteries, medications to lower cholesterol are available. Early diagnosis and treatment of diabetes mellitus and hypertension can make a difference in the progression of arthrosclerosis. Smoking cessation might also help reduce this disorder.
Many of the medications used to treat hypertension, heart disease, allergy, insomnia, stomach acidity, and depression have side effects which influence brain function and can increase the likelihood of falling. In this time of specialization, it is possible for one patient to receive prescriptions from several physicians that might have additive side effects on brain and sensory function. Patients should keep a complete list of all their medications from several physicians that might have additive side effects on brain and sensory function. Patients should keep a complete list of all their medications and dosages, and make this list available to each physician they consult.
Coordination of all medications through a single primary care physician would help avoid adverse drug reactions. This requires that the patient purchase all medications from the same pharmacy, or list all medications with each pharmacy. Unfortunately, some over-the-counter medications such as antihistamines, sleeping medications, analgesics, and cough suppressants can add to the side effects of prescription medications. Alcohol also affects movement and judgement and adversely interacts with many medications.
What about patients who have already fallen? Although rehabilitation is not perfected, much can be done.
All correctable problems should be treated. Visual correction with proper eyeglasses, improvement of hearing by hearing aids, adjustment or elimination of medications, and correction of hypertension or any other disease which could impair balance must be accomplished.
Rehabilitation includes increasing the range of motion as well as physical strength. A very important part of rehabilitation is helping patients overcome their fear of falling and thus avoid further injury. Walkers and canes can aid stability, and adaptations in the home are important. Simple changes, such as installing hand holds in bathrooms or along walls, could decrease the likelihood of falling and increase patient confidence. Removing the patient from a familiar environment, or drastically changing it, often hampers recovery.
As soon as possible, rehabilitation should be moved to an outpatient setting with participation of family members and home support groups. Rapid return to physical activity and social interaction with family and community can often stop the vicious spiral into inactivity, reclusiveness, and progressive deterioration.
Bryn Mawr Hospital MOB North
830 Old Lancaster Rd.
Bryn Mawr, PA 19010
Main Line Health Center in Newtown Square
3855 West Chester Pike
Newtown Square, PA 19073
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