Vertigo (cont.)
How are patients with balance disorders evaluated?
The most important part of the evaluation is the patient's description of
the symptoms of the balance disorder. As already mentioned, it is important for
the patient to describe the details of what they are experiencing, and try to
avoid using general terms such as dizzy or vertigo. What's more, the doctor
will ask other important questions as well. For example, how long and how often
have they had the problem? Does the symptom of the balance problem occur in
attacks or is it constant? Is it triggered by movement or by arising from a
sitting or lying position? Is it associated with other symptoms such as hearing
loss, ringing of the ears (tinnitus), ear fullness, nausea, or vomiting? Have
there been any general health changes, new medications, recent head trauma, or
recent or current infections. Are there any other neurological symptoms, such as
weakness, vision problems, or tingling?
It is important to explore any factors that trigger and cause the balance
disorder. Specifically, these factors might include change of body position,
relation to movement, and association with stress or hyperventilation. For
example, vertigo that occurs while turning in bed is typical of benign
positional vertigo. In contrast, lightheadedness brought on by getting up
quickly from a lying or sitting position is typical of a condition called
orthostatic (positional) hypotension (low blood pressure).
And, emotionally
triggered attacks may be associated with anxiety or
hyperventilation.
The duration of an attack of vertigo is very helpful in determining the
cause. For example vertigo that follows head movement and lasts less than a
minute is typical of benign positional vertigo. But an attack of vertigo lasting
hours is more commonly due to Meniere disease. Constant vertigo, however, is
typically not an inner ear disorder, but more commonly is a central nervous
system problem.
A general physical examination of the ears, head, and neck should be done
with special emphasis on tests of balance function. Additional testing is often
recommended such as hearing tests, CT scans, MRI scans (magnetic resonance imaging), electronystagmography
(ENG), and blood tests. ENG is a technique to measure involuntary eye movements
(nystagmus) that are related to balance disorders. In some situations, referral
to an ear specialist (otolaryngologist) or neurologist may also be necessary. In
addition, consultations with a cardiologist, psychiatrist, and general internist
are often indicated.
What general advice can be given to patients with balance disorders?
Balance disorders can often be very unpredictable. Depending on the cause,
the symptoms can occur at any time, even after long periods of absence of
symptoms (remission). It is important, therefore, to take proper precautions in
order to avoid accidents that could be caused by a balance disorder. The
following is a list of general recommendations for people with balance
disorders:
- Change your position slowly, especially when going from a lying down or
sitting to a standing position. When you get out of bed, sit on the side of the
bed for several minutes to gain your orientation and allow your circulatory
system to adjust.
- When walking, focus on distant objects. Do not look down at your feet.
Avoid walking in dark areas or on unstable ground.
- When riding in a car, try to sit in the front seat. Look out the window at
a fixed point. When going around curves, look at a distant object beyond the
curve.
- Maximize the function of other sensory systems, such as hearing and sight.
Investigate the need for new glasses or hearing aids.
- Use a cane, walking stick, or walker for support and to give additional
pressure and touch (tactile) orientation.
- If you are having attacks of dizziness, do not drive or operate machinery
until your doctor says it is safe to do so. Avoid climbing ladders or other
situations that may be dangerous should you suddenly feel dizzy.
- Be especially cautious when using medications that may cause balance
problems as a side effect.
Next: How are balance disorders treated? »
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