Horizon Balance and Dizziness Center

Causes of Dizziness and Imbalance

BPPV: Benign Paroxysmal Positional Vertigo

    BPPV is a condition where the otoconia (sometimes referred to as ear crystals), which is housed in the saccule, and the utricle of the inner ear, become displace and end up floating in one of the three semi-circular canals. The saccule senses movement and the direction of gravity, and when it becomes displaced, it can lead to the the following symptoms:

        - Spinning vertigo and nausea lasting 5-30 seconds.

        - Mild sense of imbalance.

        - Vertigo is triggered by laying down, rolling over in bed, looking up or bending over. There is often a slight delay (a few seconds) of the onset of vertigo when you initially assume these positions

    BPPV is the most common type of Vertigo and is easily treated in most cases. Treatment last just 1-3 visits. Due to the ease of this treatment, you should not hesitate to seek treatment. There is no reason to continue to suffer.

 

Vestibular Neuritis

    In most cases a definitive cause is never proven, but due to changes in the branches of the vestibular nerve there is evidence to support a viral cause. Onset may follow an infection of the upper respiratory of gastrointestinal tracts. The infection can happen simultaneously with the vestibular neuritis or as much as two weeks prior to the vestibular neuritis.

Symptoms:

            - Spinning vertigo and nausea lasting 24-72 hours

            - Often preceded by an upper respiratory or gastrointestinal infection but can be spontaneous.

            - Visual clarity is poor with head movement but it is normal if standing still.

            - Vertigo is worsened by rapid movements of the head.

            - Imbalance

    Vestibular Neuritis is most common between the ages of 30-60. Most symptoms will gradually resolve within 6 weeks. Rehabilitation significantly speeds recovery and helps in reaching a full recovery.

** See picture: vestibular nerve connecting ear to brain**

 

Meniere's Disease

    A Meniere's attack is generally believed to come from fluctuating pressure of fluid within inner ear labyrinth.

Symptoms:

            - Spinning vertigo lasting 30 minutes to 24 hours.

            - Fluctuation in hearing, tinnitus, pressure or fullness in the ear and the inability to tolerate loudness.

            - Gradual, permanent hearing loss.

            - Imbalance also occurs with attacks.

    Meniere's Disease is treated with diet and medication. If symptoms persist surgery is considered.

                            Normal Labyrinth                                                        Engorged Labyrinth

 

Perilymphatic Fistula

    This is leak between the inner ear and the middle ear. These leaks are usually found after trauma due to severe pressure changes (such as diving), however there are occurrences of spontaneous leaks. There are no preoperative diagnostic tests to confirm Perilymphatic Fistula, and often time the results of surgical exploration are inconclusive.

Symptoms:

            - Episodes of vertigo which is improved with rest and worsens with activity, sneezing, straining, and nose blowing.

            - Disturbance of vision while walking, hearing loss, imbalance, and loud tinnitus.

    Perilymphatic Fistulas usually heal and a full recovery is common. If symptoms persist surgery is considered.

 

Vestibular Paroxysmia

        Repeated bouts of vertigo that is associated with damage to the 8th nerve.

Symptoms:

            - Attacks of spinning vertigo lasting 20 seconds to several minutes

            - Attacks are triggered by specific head positions and can be reduced with changing head position.

            - Tinnitus can be permanent or just during the attack.

    Vestibular Paroxysmia is treated with medication and surgery, if needed.

 

Bilateral Vestibular Disorders

    May occur as a result of meningitis, labyrinthine infection, otosclerosis, Paget's Disease, polyneuropathy, bilateral tumors, endolymphatic hydrops, Meniere's Disease, ototoxic drugs, inner ear autoimmune disease, or congenital malformations.

Symptoms:

            - Vertigo, hearing loss, imbalance, and inability to maintain balance in Darkness.

    **Bilateral Vestibular disorders have many causes but can be managed with balance retraining**

 

Causes of Imbalance without Dizziness

    - Stroke

    - Deconditioning (lack of use/weak muscles)

    - Cervical (neck) Restrictions

    - Fear of Falling

    - Or any combinations of the above

    For any reason if we become less active and become more sedentary, out bodies lose the ability to keep our balance because we simply don't ask it to use it for balance often enough. Treatment for imbalance requires training in situations that ask you to use your balance. Treatment can be intimidating at first, but it can also be very rewarding to regain independence through balance training.