A lot of people overlook symptoms of vertigo, lightheadedness, spinning, imbalance, or unsteadiness because they can be episodic, subside, or be alleviated with medications. However, these symptoms are disruptive to daily life and can impact your quality of life.
Pinpointing the source of a balance problem and coming up with an accurate diagnosis to put all the pieces together requires a thorough analysis of a patient’s medical history to evaluate all symptoms as well as comprehensive vestibular function testing.
Medical History
The first step in diagnosing a patient with balance issues or dizziness is obtaining a comprehensive history of symptoms and occurrences. Some of the things that are important to consider include:
- Onset of dizziness. Was it sudden or gradual?
- Duration – does it last minutes, hours or days?
- Is the dizziness constant or does it occur in episodes?
- Are the symptoms improving?
- What causes the symptoms to worsen?
- Are there any accompanying audiological symptoms such as hearing loss, pain in the ears, fullness, or tinnitus (ringing or sounds in the ears)?
- Is there a history of allergies or migraines?
- Is there a history or family history of heart problems or high blood pressure?
- Have there been any recent head trauma or changes in vision?
- Are there any neurologic symptoms including numbness or weakness in the face or extremities?
Each of these questions provide more information to help identify if the cause of the symptoms is related to the ear or if other specialties need to be involved in the diagnosis, such as cardiology, allergy, physical therapy, ophthalmology, or neurology.
Vestibular Function Testing
The vestibular function testing that is performed at an audiologist’s office searches for common causes of vertigo symptoms including Meniere’s disease, benign paroxysmal positional vertigo (BPPV), labyrinthitis and vestibular neuritis, as well as other common etiologies.
Meniere’s disease is associated with a buildup in fluid pressure inside the inner ear. In addition to attacks of vertigo, a patient can also experience fluctuating levels of hearing loss, tinnitus (ear ringing or roaring) and a sense of fullness in the affected ear.
BPPV, a fairly common diagnosis, results when crystals inside the ear become dislodged. Calcium crystals, normal structures in the inner ear, break loose and can float into another part of the ear. This causes a spinning sensation when changing head positions, usually triggered by movement, such as getting out of or into bed, when laying down, rolling over onto the side, and even sometimes bending over and looking upward to grab something out of the kitchen cabinet. Each episode is brief, on the order of seconds to less than a minute.
Labyrinthitis and vestibular neuritis are disorders that result from an infection that can affect the transmission of sensory information from the ear to the brain. Symptoms can result in vertigo, dizziness, and balance, vision, and hearing issues. Labyrinthitis occurs when an infection can affect both branches of the vestibulo-cochlear nerve, resulting in hearing changes along with dizziness or vertigo. Vestibular neuritis affects the branch associated with balance, resulting in dizziness or vertigo, but no change in hearing. Symptoms usually last on the order of weeks to sometimes months and improve over time with the use of medications to control the nausea and suppress dizziness. In some cases, vestibular rehabilitation exercises help following medication therapy.
Although it may be difficult to identify what may have caused your symptoms, the proper diagnosis is vital for effective treatment. Some balance problems begin with allergies or a bad cold. Others are due to autoimmune disorders. A head injury can trigger episodes of vertigo or disequilibrium. Chronic neck pain or stiffness can cause vertigo or imbalance. In yet other cases, it’s unclear what may have brought on the condition.
Treatments for balance disorders
Treatment depends on the diagnosis and can range from oral medications for symptom alleviation to physical therapy for balance retraining to surgical procedures. Treatment for BPPV involves repositioning the dislodged ear crystals through repositioning maneuvers to get the crystals back in place.
For some conditions, anti-nausea drugs may be prescribed to alleviate the symptoms associated with vertigo. Other patients will benefit from dietary adjustments such as a low-salt diet, or possibly surgical options to correct physical abnormalities associated with particular disorders. Many patients benefit from physical therapist directed vestibular rehabilitation therapies.
If you or someone you know is suffering from balance issues, come see us today so we can help restore a healthy balance to your life!