Balance Lab

ABHC FACTS

-Balance disorders and falls are on the increase as the aging population live longer. The statistics are sobering: About 30 percent of persons aged 65-74 report falls in any given year. For those over 65, falls in the home cause 60 percent of fatalities. Fractures from falls are a leading cause of disability and often result in entering a nursing home. We screen people who may be at risk for falling, provide early intervention and our rehabilitation program retrains patients with balance and dizziness disorders.

- We make hearing conservation, education and testing available to local industries, schools, and municipalities.
It is estimated that 20% of graduating high schoolers have some hearing decrease, most of it caused by exposure to excessive noise. Noise induced hearing loss is prevalent among farmers, factory workers, small industry workers, hunters and others.Many of these receive little or no hearing conservation services.

Vertigo
Vertigo is the sensation of motion when no motion is present. The person experiencing vertigo often describes the sensation as whirling or spinning. At times vertigo is reported as dizziness. This is a confusing term, however. Dizziness may also represent light headedness which is not the same as vertigo. Vertigo is due to an abnormality in the vestibular system which controls balance and eye tracking motions. The problem may be located in the ear or in the brain. Light headedness is usually a problem with blood flow to the brain and may be due to a number of causes involving the cardiovascular or nervous systems.

True vertigo has many different causes and the work-up is usually quite involved. In a surprising number of cases, the cause is never identified. The goal of the work-up is to eliminate serious causes that may be life-threatening or that may result in other organ system involvement. Whether or not the cause is identified, an attempt is made to treat the vertigo. The general basic work-up includes a hearing test, several laboratory blood tests, and perhaps a specialized balance test, called an electronystagmogram (ENG). Depending on the results of these initial tests, other tests may be ordered, including more advanced hearing tests and possibly magnetic resonance imaging (MRI).

Metabolic causes of vertigo include high blood pressure, high cholesterol, diabetes, thyroid disease, anemia, and calcium disorders. Autoimmune causes include rheumatoid arthritis, lupus, sarcoid, and other more rare disorders. Infectious diseases such as syphilis may also cause vertigo. The above causes can be identified by laboratory testing. Treatment of these conditions may not improve the vertigo.

Viral labyrinthitis is an inflammation of the inner ear that can follow the common cold. The vertigo that develops usually resolves spontaneously but may last for several months. Persistent cases may respond to vestibular exercises. Bacterial labyrinthitis is a life-threatening infection that presents with severe vertigo, vomiting, and high fevers. This condition requires immediate hospitalization.

Acoustic neuroma is a benign tumor that forms on the nerve of hearing or the nerve of balance between the ear and the brain. It can usually be cured with surgery but can be life-threatening if untreated. Hearing and balance tests can identify this tumor but MRI is needed to confirm its presence.

Benign positional vertigo is the most common cause of vertigo. It results from sudden head movements (i.e. rising out of bed) and only lasts for a few seconds before resolving. The vertigo is caused by calcium deposits that tumble through the inner ear with sudden motion. This condition usually responds to vestibular exercises that cause the brain to compensate for the stimulus.

Meniere’s disease is a condition where fluid builds up in the inner ear, resulting in episodic vertigo, pressure in the ear, and a fluctuating hearing loss and ringing in the ear. The vertigo usually lasts for hours. There is no one diagnostic test for Menieres disease, but the history and results of the hearing and balance tests may suggest the diagnosis. The first treatment for Meniere’s disease is diuretic therapy with potassium supplementation. If this fails, various surgical procedures to lower inner ear pressure may relieve the vertigo. In most cases, the hearing continues to worsen.

Allergies, particularly to foods, may lead to build up of inner ear fluid and to symptoms that mimic Meniere’s disease. Identification and treatment of these allergies usually results in an improvement in these symptoms.

Finally, various neurological problems, such as multiple sclerosis and brain tumors, can present with vertigo. Balance testing will often separate inner ear causes of vertigo from those related to the central nervous system. Treatment of these conditions require neurologic consultation.

Regardless of the cause of vertigo, some medications may relieve the symptoms. Meclizine (Antivert) is an antihistamine that affects the vertigo center in the brain and usually decreases the sensation in cases of mild vertigo. For severe symptoms, however, Valium may be necessary. If medical therapy fails, surgical procedures may be necessary to control vertigo. Besides those procedures to lower inner ear pressure in Meniere’s disease, other operations include clipping the nerve of balance and drilling out the inner ear to stop vertigo when there is no serviceable hearing present.