Balance Problems – Don’t Ignore Them!
On occasion, I hear from patients who complain of feeling dizzy as if they are going to fall when they turn their head suddenly, or lose their balance if they turn around in a circle. They may also admit to motion sickness, i.e., feeling a little dizzy and unstable riding a bike or traveling by airplane or boat.
Balance problems such as these could be a sign of certain medical conditions. There are many types of balance difficulties and their causes can be simple, such as a drop in blood sugar or dehydration from not drinking enough water.
Other equilibrium problems may be more complex and need neurological testing to determine their cause. Let me explain the various types of conditions that effect balance and their possible causes so you can determine if you need to call your doctor, or re-hydrate with a good mineral replacement drink, or have a glass of orange juice and a snack!
Types of Balance Problems
As I said earlier, balance problems can have simple or complex causes. Basically, they fall into four categories:
Vertigo – a spinning, dizzy sensation with motion of the head or body. This category can be caused by several medical conditions that need a doctor’s care. These include:
•Benign positional vertigo – caused by particles that accumulate in the inner canal.
•Meniere’s disease – excessive fluid in the inner ear, causing dizziness, ringing or buzzing.
•Vestibular migraine – a bad headache that makes you sensitive to motion, turning your head suddenly can result in dizziness or off balance feeling.
•Acoustic neuroma – caused by a tumor on the acoustic nerve (connects inner ear to brain) that can cause hearing loss, ringing Blood balance in the ears, and dizziness.
•Motion sickness – riding on amusement park rides, boats causes dizziness.
Feeling Faint – a general weakness, usually organic cause (blood pressure or blood sugar drop)
Disequilibrium – a loss of balance or falling, usually from mechanical causes (unstable joints, failing vision, inner ear conditions, side effect of medication).
Lightheadedness – an “out of body” sensation, usually caused by high/low blood oxygen levels from hyper/hypoventilation (anxiety, severe trauma), or inner ear conditions.
Tests for Balance Problems
If you determine that your dizziness/balance problem is not a result of lack of food or water, the next thing you should do is make an appointment with your doctor. There are certain balance tests that can be performed, or you may be sent for a CAT scan or MRI of your head to see if there are any structural causes of your balance problems (like tumor or inner ear abnormality).
Your doctor will discuss your balance problems with you and may ask a series of questions about your dizzy spells including the frequency, what you are doing when they occur, and what type of medications you may be taking to rule out the possibility of a side effect. Next, you may undergo one, or several of the following tests to pinpoint the cause of your symptoms:
EKG, possibly heart echocardiogram: To see if a too slow heart rhythm, or too low blood ejection from your heart could be the cause of your symptoms.
MRI or CAT scan: To determine if there is any physical abnormality such as a tumor or blood vessel blockage that may cause your symptoms.
Tilt Table test: To determine your heart’s response to adrenaline, such as in an anxiety attack or severe trauma. Adrenaline is slowly injected into your arm and the table you are lying on is tilted in different positions.
Hearing test: To determine if you have an inner ear condition.
Electronystagmography – monitors eye movement to see how well your inner ear/balance works.
Dix-Hallpike test – involves turning your head and monitoring eye movements to see if you get a sense of spinning or motion.
VEMP – vestibular evoked myogenic potential test. Electrodes (like those on an EKG) are placed on neck, shoulder, and forehead muscles to monitor contractions in response to sound.
Rotary Chair test – monitors eye movement while you move slowly in a circle in a computerized chair.
Treatment for Your Balance Problem
Once the cause of your imbalance has been determined, there are a number of treatments aimed at solving your problem. These may include:
•Medication dosage adjustment/discontinuation/substitution – often a dosage change is all that is needed to stop symptoms. Other times, a complete discontinuation of a drug is necessary.
•Vestibular rehabilitation – this is a special exercise program for people with inner ear problems to re-stabilize balance.
•Fall prevention – determining if vision, lack of sensation in the feet, weak muscles and joints are contributing to poor balance symptoms. You may need a walker or just a hand held quad cane.
•Positioning procedures – clears crystal deposits out of the inner ear back where they belong.
•Diet changes – reducing salt, caffeine or nicotine can help some people with balance problems completely get rid of their symptoms.
•Surgery – if you have a tumor or malfunction in your inner ear, you may need surgery to correct it. Types of surgery include gamma knife surgery, or stereotactic surgery that delivers radiation directly to the tumor site.