Dizziness, a blanket term used to describe any feeling of instability, is one of the leading health complaints in the United States and affects an estimated 9 million people annually. For those over the age of 70, it’s the top reason for a visit to the doctor’s office.
In 2015, the total medical costs for falls totaled more than $50 billion, according to the CDC. Medicare and Medicaid shouldered 75% of these costs.
What Are the Causes of Dizziness?
Dizziness occurs when your brain receives false signals from the balance system (comprised of the inner ear, eyes and sensory nerves). It senses movement and overcompensates, leading to a spinning sensation, weakness and faintness.
In most cases, dizziness is a symptom of an underlying condition as opposed to its own disease. Causes of dizziness include low blood pressure, anemia, dehydration, heat-related disorders, endocrine system disorders (e.g., diabetes, thyroid disease), heart conditions, high blood pressure, viral and bacterial infections, head trauma, hyperventilation, neurological disorders and certain medications.
Several balance disorders are commonly associated with dizziness and/or vertigo.
- Benign Paroxysmal Positional Vertigo (BPPV) involves brief but intense periods of vertigo that are triggered by specific changes in head position. It occurs when tiny crystals in the otolith organs become dislodged and migrate to the semicircular canals.
- Meniere’s disease is a chronic condition that causes vertigo, tinnitus, fullness in the ear and fluctuating hearing loss that may eventually become permanent. Meniere’s is usually confined to one ear, and though its cause is unknown, it may be the result of abnormal fluid buildup in the inner ear.
- Labyrinthitis is an inflammation of the inner ear usually caused by an infection. Its symptoms include vertigo, temporary hearing loss and tinnitus.
What Other Symptoms Are Associated with Dizziness?
Patients who experience dizziness report a variety of symptoms depending on the exact nature of their balance disorder. These include:
- Vertigo (the sensation of movement in your surroundings)
- Blurred vision
How Do We Treat Dizziness?
Treatment for dizziness takes many forms, depending on the cause. We will target the underlying condition to reduce or eliminate your symptoms.
Treatment options often include medications (antihistamines, sedatives, antibiotics, steroids), physical or occupational therapy, surgery, repositioning exercises, vestibular retraining programs and lifestyle modifications such as dietary changes and elimination of alcohol and nicotine.
As there is little representation of the balance system in the conscious mind, it is not unusual for someone to have difficulty describing their symptoms to their primary care provider. Since the symptom of dizziness varies so widely from person to person and may be a result of multiple diseases, doctors may require several tests to provide a patient with additional knowledge about the cause of their dizziness. If you experience vertigo or balance issues, ask your primary care provider to refer you to our specialists for a balance function assessment.
BALANCE AND EQUILIBRIUM DIAGNOSTIC ASSESSMENT
WHAT TESTS WILL BE PERFORMED?
Audiology tests can provide information about hearing, middle ear function, cochlear hair cell function and several neural aspects of the hearing-balance system. Although there are many ear related conditions, which cause hearing loss along with vertigo, there are many that do not. So, the presence of an accompanying hearing loss with the vertigo symptoms may help differentiate certain ear disease-disorders from one another.
Audiology testing often includes: Pure tone (air and bone) and word discrimination tests as well as Immittance Audiometry which evaluates middle and inner ear and some neurological pathways. Otoacoustic Emissions is a relatively new test that looks at the outer hair cell function within the inner ear (cochlea). Brainstem Auditory Evoked Response (BAER) tests the neural conductivity of the hearing and balance nerve (CN VIII).
Gans Sensory Organization Performance Test:
A combination of the Romberg, clinical test of sensory integration of balance (CTSIB) and Fukuda Stepping Tests provide qualitative information on whether an equilibrium dysfunction exists, whether it is CNS or peripheral and also serves as an indicator of impact on balance function. Whether the is patient surface or visually dependent gives insight into the status of the vestibular system. Recovery of function post treatment may also be documented.
Computerized Dynamic Visual Acuity Test (CDVAT):
This tests for a change in vision with controlled head movement. Oscillopsia is a breakdown in gaze stabilization during active head movement caused by peripheral or central vestibular disorders. The vision test is conducted while the patient produces horizontal and then vertical head movement of 2.5 cycles per second. The test indicates the function problem caused by the vestibular dysfunction and can be used as a baseline to latter compare improvement post Vestibular Rehabilitation Therapy (VRT) to document the treatment efficacy.
Vestibular Autorotation Testing:
VOR function gain and phase is quantitatively analyzed using this active rotation test for both horizontal and vertical head movements over a frequency range of approximately 2-8 cycles per second. The patient is required only to look straight ahead while moving their head to an auditory cuing signal. This test provides diagnostic as well as outcome measurements. This test can be obtained through passive tests like the Rotary Chair, in which the patient simply sits while being harmonically accelerated, or active tests, in which the person volitionally moves their head to an auditory cue.
Vestibular-Evoked Myogenic Potentials (VEMPs):
Vestibular-evoked myogenic potential testing (VEMPs) is based on the reflex, which occurs between the otolith system (specifically the saccule), and the sternocleidomastoid muscle (SCM). The vestibulo-collic reflex (VCR) has been well studied in animals and humans. The benefit of VEMPs is there is no other vestibular function test, which provides information regarding the saccule or its innervation by the inferior branch of the vestibular nerve. As the VCR is a classic reflex arc with a sensory, CNS, and motor output component, it has been used to provide information regarding both the integrity of the saccule and inferior vestibular nerve, as well as the reflex arc through the brainstem. This has provided information on both otologic and neurologic conditions.
Videonystagmography (VNG) Testing
A VNG is a series of tests that evaluate the health of your vestibular (balance portion of inner ear) and your central motor function. VNG testing can help to uncover the root cause of your vertigo, dizziness or balance issues, and allows your doctor or hearing specialist to treat it appropriately and effectively.
Most VNG evaluations consist of four main tests:
This test checks for your ability to follow visual targets, such as a moving light on a bar. You will attempt to follow targets with your eyes while an object is jumping, moving slowly, or standing still. Inability to track objects properly could indicate central or neurological problems or possibly an issue with the vestibular system connecting to the brain. Recording and evaluating eye movements is helpful because visual motor neural pathways are connected to the vestibular or balance system of the inner ear.
This test also checks for your ability to follow visual targets. During this test, you will watch an image that is continuously moving and will be asked to follow the movements. Similarly, this test will give clues to possible central or neurological problems or problems with the vestibular system.
This test will help give an idea of the health of your inner ear system. You will be asked to move your head and body into different positions, allowing the hearing care professional to check for inappropriate eye movements in each position.
This test can help determine if you have vestibular weakness in one or both ears by checking to see if your vestibular system responds properly to stimulus. Your eyes will be monitored while your inner ears are stimulated (one at a time) with warm or cold air.
PREPARING FOR YOUR BALANCE AND EQUILIBRIUM DIAGNOSTIC ASSESSMENT
Our staff will provide you with clear instructions on how to prepare for your examination. We may ask you to discontinue certain medications, not to consume any alcoholic beverages or caffeinated drinks at least 48 hours before the tests, to remove contact lenses or eyeglasses or to fast for a few hours prior to testing. The exact instructions may vary from patient to patient. If you have any questions about your instructions or how to prepare for the test, ask your hearing health professional.
The entire evaluation typically takes about 2 hours to complete. Patients may experience some symptoms of dizziness afterward. It is advised that you bring someone with you who can drive you home afterward, if you are unable to drive or do not feel well after the tests.
Our audiologists are certified by the American Institute of Balance, the world’s leading authority in dizziness and balance diagnosis and management.
Call Audiology Center of Maine at (207) 664-2123 for more information or to schedule an appointment.