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Dizziness & Balance

What are balance disorders?

A balance disorder makes patients feel dizzy or unsteady even when they are lying down or standing still. Many balance disorders are caused by a problem with the vestibular system, part of the complex inner anatomy that helps the body maintain balance.

The vestibular system is composed of sections of the brain and inner ear that help control balance and eye movement. If any part of a vestibular system is compromised, patients may experience one or more of the following symptoms:
  • Dizziness
  • Vertigo
  • Loss of balance
  • Loss of spatial orientation
  • Vision disturbances
  • Hearing loss
Not all patients with a balance disorder will experience these symptoms. If experienced, these symptoms may be new and frightening, and may be difficult to describe accurately. Balance disorders often interfere with daily life, such as going to work, school or even getting out of bed in the morning.

What are the causes of a balance disorder?

Balance problems can be caused by many different conditions, including:
  • Benign Paroxysmal Positional Vertigo
  • Tinnitus: a ringing in the ears that is often a symptom of an ear injury or age-related hearing loss
  • Ototoxicity: poisoning of the inner ear resulting from exposure to drugs or chemicals
  • Ménière's Disease: a chronic condition affecting the inner ear that causes sudden episodes of vertigo
  • Labyrinthitis and Vestibular Neuritis: disorders resulting from inflammation of the inner ear or the nerves that connect the inner ear to the brain
  • Cholesteatoma: a skin cyst that forms in the middle ear and skull bone
  • Age-related dizziness and imbalance
Benign Paroxysmal Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is a type of vertigo that causes short periods of mild to severe dizziness. BPPV episodes are triggered when a person moves their head, such as nodding, lying down or sitting up. Patients with BPPV may also feel a loss of equilibrium when they are standing or walking.

BPPV episodes usually last less than a minute. Sometimes they occur frequently, only to disappear for a time and return later. Though BPPV is difficult to live with, it is rarely serious unless it increases the likelihood a person might fall down.

The first step toward treating BPPV is to schedule an appointment with a board-certified Temple head and neck surgeon. Our physicians have extensive experience pinpointing the root cause of the problem. Many times, BPPV is associated with mild head injuries, migraines or damage to the inner ear.

Once our physician have diagnosed the cause, they can offer several treatment options, including lifestyle changes, non-surgical canalith repositioning—a procedure that slowly repositions particles within the inner ear—or surgical alternatives, such as using bone plugs to block the section of the ear causing dizziness.

What are the diagnostic tests for balance disorders?

Before a balance disorder can be treated, the cause must be accurately diagnosed. Temple's board-certified head and neck surgeons offer several leading-edge diagnostic services to pinpoint the cause of a balance disorder, including:

  • Electronystagmography (ENG)
  • Videonystagmography (VNG)
  • Vestibular Evoked Myogenic Potential testing (VEMP)
  • Electrocochleography (ECochG)
  • Video Head Impulse Test (vHIT)

What are the treatment options for balance disorders?

  • Medications to reduce motion sickness or nausea may be useful during the first five days of a balance disorder. Antibiotics may be prescribed if a middle ear infection is present. Medications are not recommended for long-term use, as the body must naturally adjust to compensate for a vestibular disorder.
  • Balance therapy is an exercise-based program that encourages the central nervous system to adjust to inner ear problems and compensate for a lack of balance, leading to a greater sense of equilibrium.
  • Injections of antibiotics into the inner ear can reduce the number of vertigo episodes experienced by patients with Ménière's Disease.
  • Surgery may be considered when medications and balance therapy are unable to control the symptoms of a vestibular disorder. The goal of surgery is to repair or stabilize the function of the inner ear, or block unwanted sensory information traveling from the inner ear to the brain.