Dizziness and balance disorders

Vestibular migraine is a type of migraine that affects balance function and spatial orientation. Individuals with vestibular migraine may experience symptoms such as vertigo (a sensation of spinning or motion when at rest), dizziness, imbalance, nausea, and sensitivity to light or sound.

The exact cause of vestibular migraine is not fully understood, but it is believed to involve abnormal activation or dysfunction of the vestibular system in response to migraine triggers. These triggers include certain foods, stress, hormonal changes, sleep disturbances, weather changes and more.

Diagnosis of vestibular migraine is typically based on clinical symptoms and medical history, although additional tests such as vestibular function tests or imaging studies may be conducted to rule out other possible causes of symptoms.

Treatment for vestibular migraine often involves a combination of lifestyle modifications, dietary changes, medications to manage migraine symptoms and prevent attacks, and vestibular rehabilitation therapy to improve balance and reduce symptoms of dizziness and vertigo. Additionally, identifying and avoiding triggers can help to reduce the frequency and severity of vestibular migraine episodes.

Resources:

• https://www.migrainedisorders.org/
• https://americanmigrainefoundation.org/
• https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/vestibular-migraine/

Persistent Postural-Perceptual Dizziness (PPPD), previously known as Chronic Subjective Dizziness (CSD), is a condition characterized by persistent feelings of dizziness, unsteadiness, and/or imbalance that are typically provoked or worsened by upright posture, active or passive motion, and exposure to complex or visually stimulating environments. Individuals with PPPD often report symptoms such as feeling like they are swaying, rocking, floating or bobbing, even when they are standing still.

PPPD is thought to result from a combination of factors involving sensory integration and central nervous system processing. It is not a psychiatric disorder. It may develop following an acute vestibular disorder, such as vestibular neuritis or labyrinthitis, but can also arise independently or be triggered by other factors such as migraine, anxiety or a cardiovascular event.

Diagnosis of PPPD is based on clinical symptoms and medical history, as there are no specific diagnostic tests for the condition. Healthcare providers may perform a thorough evaluation to rule out other potential causes of dizziness and balance problems.

Treatment for PPPD typically involves a multidisciplinary approach, including vestibular rehabilitation therapy to improve balance and reduce symptoms, cognitive-behavioral therapy (CBT) to address coping strategies, medications and lifestyle modifications. The goal of treatment is to help individuals manage their symptoms and improve their quality of life.

Resources:

• https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/persistent-postural-perceptual-dizziness/

Meniere’s disease is a disorder of the inner ear that affects balance and hearing. It’s characterized by episodes of vertigo (a sensation of spinning), hearing loss, tinnitus (ringing in the ear), and a feeling of fullness or pressure in the affected ear.

The exact cause of Meniere’s disease is not fully understood, but it’s believed to involve fluid buildup in the compartments of the inner ear, known as the labyrinth. This fluid buildup, called endolymphatic hydrops, can affect the function of the inner ear structures responsible for balance and hearing.

Meniere’s disease typically presents in recurrent episodes or “attacks” that can vary in duration and severity. Between attacks, individuals may experience periods of remission where symptoms improve or resolve completely. Over time, however, some individuals may develop permanent hearing loss in the affected ear. The diagnosis of Meniere’s disease is based on a combination of symptoms, medical history and diagnostic tests, which may include hearing tests, balance assessments and imaging studies to rule out other potential causes of symptoms.

Treatment for Meniere’s disease aims to manage symptoms and reduce the frequency and severity of episodes. This may involve dietary changes (such as reducing salt intake), medications to control symptoms of vertigo, vestibular rehabilitation therapy, and in some cases, surgical procedures or other interventions to alleviate fluid buildup in the inner ear. The specific treatment approach may vary depending on the individual’s symptoms and response to treatment.

Resources:

• https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/menieres-disease/

Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear disorder characterized by brief episodes of vertigo (a spinning sensation) that are triggered by changes in head position. BPPV occurs when small calcium carbonate crystals, called otoconia, become dislodged from their normal position within the inner ear and migrate into one of the semicircular canals, which are fluid-filled structures responsible for sensing rotational movement.

When the head is moved, these displaced crystals can cause abnormal fluid movement within the semicircular canal, leading to a sensation of spinning or dizziness. The vertigo experienced in BPPV is typically short-lived and triggered by specific head movements, such as rolling over in bed, tilting the head back or looking up.

Common symptoms of BPPV include brief episodes of vertigo lasting less than one minute, typically triggered by changes in head position, as well as accompanying symptoms of nausea, imbalance, and occasionally, nystagmus (involuntary eye movements).

Diagnosis of BPPV is typically based on a combination of clinical history and physical examination maneuvers, such as the Dix-Hallpike test or the supine roll test, which aim to provoke and reproduce characteristic vertigo and nystagmus associated with the condition. Additional tests, such as videonystagmography (VNG) or electronystagmography (ENG), may be performed to confirm the diagnosis and rule out other potential causes of vertigo. Treatment for BPPV often involves a series of simple maneuvers known as canalith repositioning procedures or particle repositioning maneuvers, such as the Epley maneuver or the Half Somersault maneuver, which aim to reposition the displaced otoconia within the inner ear and alleviate symptoms. These maneuvers can often provide rapid relief from vertigo and may be performed by a healthcare provider or taught for self-administration at home. In some cases, additional treatments or follow-up maneuvers may be necessary to fully resolve symptoms.

Vestibular neuritis is a condition characterized by inflammation of the vestibular nerve, which connects the inner ear to the brainstem and plays a crucial role in maintaining balance and spatial orientation. This inflammation typically results from a viral infection, often involving the same viruses responsible for causing colds or other upper respiratory infections.

The inflammation of the vestibular nerve can disrupt the transmission of signals between the inner ear and the brain, leading to symptoms such as:

• Vertigo: A sensation of spinning or whirling, typically severe and sudden in onset, often triggered by changes in head position.
• Nausea and vomiting: Vertigo associated with vestibular neuritis can be intense enough to cause nausea and vomiting.
• Unsteadiness or imbalance: Individuals with vestibular neuritis may experience feelings of unsteadiness or imbalance, particularly during episodes of vertigo.
• Nystagmus: Involuntary rapid eye movements, often characterized by horizontal or rotary movements, may occur during episodes of vertigo.

Unlike labyrinthitis, the symptoms of vestibular neuritis are typically not associated with hearing loss or tinnitus (ringing in the ears) as the inflammation primarily affects the vestibular portion of the inner ear.

The diagnosis of vestibular neuritis is based on a combination of clinical history, physical examination findings, and ruling out other potential causes of symptoms. Additional tests, such as vestibular function tests or imaging studies, may be performed to confirm the diagnosis and assess the extent of vestibular dysfunction. Treatment for vestibular neuritis often involves symptomatic management to alleviate vertigo and associated symptoms, such as anti-vertigo medications, anti-nausea medications, and vestibular rehabilitation therapy to promote compensation for vestibular deficits and improve balance. While symptoms of vestibular neuritis can be debilitating initially, most individuals experience significant improvement over time, with many achieving complete resolution of symptoms within a few weeks to months.

Labyrinthitis is a condition characterized by inflammation of the labyrinth, a complex structure within the inner ear that includes the cochlea (responsible for hearing) and the vestibular system (responsible for balance). Labyrinthitis typically occurs as a result of a viral or bacterial infection, although it can also be triggered by other factors such as allergies, autoimmune disorders or certain medications.

The inflammation of the labyrinth can disrupt both hearing and balance, leading to symptoms such as:

• Vertigo: A sensation of spinning or whirling, often severe and sudden in onset, typically triggered by changes in head position.
• Hearing loss: Labyrinthitis can cause temporary or permanent hearing loss, which may affect one or both ears. The severity of hearing loss can vary depending on the extent of inflammation and damage to the cochlea.
• Tinnitus: Ringing, buzzing or other noises in the ear may occur in individuals with labyrinthitis, often associated with hearing loss.
• Nausea and vomiting: Vertigo associated with labyrinthitis can be intense enough to cause nausea and vomiting.
• Imbalance: Feelings of unsteadiness or imbalance may occur, particularly during episodes of vertigo.

Diagnosis of labyrinthitis is typically based on clinical history, physical examination findings (such as the presence of characteristic nystagmus), and ruling out other potential causes of symptoms. Additional tests, such as hearing tests (audiometry) and vestibular function tests, may be performed to assess the extent of hearing and balance dysfunction.

Treatment for labyrinthitis often involves symptomatic management to alleviate vertigo and associated symptoms, such as anti-vertigo medications, anti-nausea medications, and vestibular rehabilitation therapy to promote compensation for vestibular deficits and improve balance. In cases where labyrinthitis is caused by a bacterial infection, antibiotics may be prescribed. Most individuals with labyrinthitis experience significant improvement in symptoms over time, although recovery may take several weeks to months, particularly in cases of severe inflammation or permanent hearing loss.

Superior semicircular canal dehiscence (SSCD) is a rare medical condition where there is an abnormal opening or thinning in the bone covering the superior semicircular canal of the inner ear. This canal is one of the three semicircular canals responsible for detecting rotational movements of the head and maintaining balance.

In SSCD, the dehiscence (opening) in the bone can lead to abnormal communication between the inner ear and surrounding structures, causing various symptoms such as:

• Vertigo: Individuals with SSCD may experience vertigo or dizziness, often triggered by loud noises or changes in middle ear or intracranial pressure.
• Dizziness or imbalance: Some individuals may feel unsteady or imbalanced, particularly in situations where pressure changes, such as during straining, coughing or sneezing.
• Hearing symptoms: While hearing loss is not a common symptom of SSCD, individuals may experience certain auditory symptoms such as sensitivity to sound (hyperacusis) or hearing one’s own voice abnormally loud (autophony).
• Pulsatile tinnitus: Some individuals may experience a pulsing or rhythmic sound in the affected ear, which can be synchronous with the heartbeat.

Diagnosis of SSCD involves a combination of clinical history, physical examination, and specialized tests such a VNG and/or a CT scan to confirm the presence of a dehiscence in the superior semicircular canal.

Treatment for SSCD may include conservative management, such as lifestyle modifications to avoid triggers, vestibular rehabilitation therapy and use of hearing protection to minimize sound-induced symptoms. In cases where symptoms are severe or significantly affect quality of life, surgical repair of the dehiscence may be considered. However, the decision for surgical intervention is based on individual symptoms, severity and patient preferences, and should be discussed with a healthcare provider experienced in managing SSCD.

Post-concussion dizziness refers to dizziness or vertigo that occurs following a concussion, which is a type of traumatic brain injury typically caused by a blow to the head or a sudden jolt to the body. Dizziness is a common symptom following a concussion and can significantly impact an individual’s daily functioning and quality of life.

Post-concussion dizziness can manifest in various ways, including:

• Vertigo: A sensation of spinning or whirling, often triggered by changes in head position.
• Lightheadedness: A feeling of faintness or feeling like one might pass out.
• Unsteadiness: A sense of imbalance or feeling like one might fall.
• Visual disturbances: Blurred vision, sensitivity to light or difficulty focusing may occur.
• Nausea: Dizziness can often be accompanied by feelings of nausea or vomiting.

The exact mechanisms underlying post-concussion dizziness are not fully understood but may involve dysfunction of the vestibular system (responsible for balance) or other structures within the inner ear and brain that regulate balance and spatial orientation. Additionally, factors such as inflammation, changes in blood flow or disruptions in neurotransmitter function may contribute to dizziness following a concussion. Management of post-concussion dizziness typically involves a multidisciplinary approach, including rest and gradual return to activities, symptomatic management (such as medications for dizziness or nausea), vestibular rehabilitation therapy to improve balance and reduce symptoms, and cognitive-behavioral therapy (CBT) or other psychological interventions to address anxiety or other emotional factors that may exacerbate symptoms.

It’s essential for people experiencing post-concussion dizziness to seek evaluation and management from a healthcare provider experienced in treating concussion and related symptoms. A comprehensive assessment can help identify the underlying causes of dizziness and guide appropriate treatment strategies to promote recovery and improve quality of life.

Fall risk in the elderly is a significant concern due to the increased likelihood of falls and potential for serious injuries. Several factors contribute to the increased risk of falls among older adults:

• Age-related changes: As people age, changes in vision, balance, muscle strength and coordination can increase the risk of falls.
• Medical conditions: Chronic health conditions such as arthritis, osteoporosis, Parkinson’s disease, stroke, diabetes and cardiovascular disease can affect mobility and increase fall risk.
• Medications: Certain medications, especially those that affect blood pressure, balance or cognition, can increase the risk of falls. Polypharmacy (taking multiple medications) is also a risk factor.
• Environmental factors: Hazards in the home environment, such as poor lighting, slippery floors, uneven surfaces and lack of handrails or grab bars, can contribute to falls.
• Nutritional factors: Malnutrition, dehydration, and vitamin D deficiency can weaken muscles and bones, increasing the risk of falls.
• Cognitive impairment: Conditions such as dementia or Alzheimer’s disease can affect judgment, spatial awareness and decision-making, leading to an increased risk of falls.

To reduce fall risk in elderly individuals, it’s essential to implement preventive strategies:

• Regular exercise: Engaging in regular physical activity to improve strength, balance and flexibility can help reduce fall risk. Activities such as walking, tai chi and strength training are beneficial.
• Medication management: Reviewing medications with a healthcare provider to identify potential side effects or interactions that may increase fall risk. Minimizing the use of sedatives, tranquilizers and medications that lower blood pressure can be beneficial.
• Home modifications: Making modifications to the home environment to remove hazards and improve safety, such as installing handrails, grab bars, nonslip mats and adequate lighting.
• Vision and hearing checks: Regular vision and hearing assessments can identify impairments that may contribute to falls. Corrective lenses and hearing aids can help improve sensory function.
• Nutrition: Ensuring adequate intake of nutrients, including calcium and vitamin D, to support bone health and muscle strength.
• Fall detection and response: Using devices such as medical alert systems or fall detection sensors can provide assistance in the event of a fall.
• Regular healthcare visits: Regular check-ups with healthcare providers to assess overall health, mobility and fall risk, and to address any underlying medical conditions or concerns

By addressing these factors and implementing preventive measures, the risk of falls in elderly individuals can be reduced, promoting safety, independence and quality of life.