Vestibular Balance Disorders (cont.)
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How is a balance disorder diagnosed?
Diagnosis of a balance disorder is difficult. There are many potential causes - including medical conditions and medications.
To help evaluate a balance problem, your doctor may suggest you see an otolaryngologist. An otolaryngologist is a physician and surgeon who specializes in the ear, nose, and throat. An otolaryngologist may request tests to assess the cause and extent of the balance problem depending on your symptoms and health status.
The otolaryngologist may request a hearing examination, blood tests, an electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of your head and brain. Another possible test is called posturography. For this test, you stand on a special movable platform in front of a patterned screen. The doctor measures how your body moves in response to movement of the platform, the patterned screen, or both.
How is a balance disorder treated?
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The first thing a doctor will do to treat a balance disorder is determine if your dizziness is caused by a medical condition or medication. If it is, your doctor will treat the condition or suggest a different medication.
Your doctor also may describe ways for you to handle daily activities that increase the risk of falling and injury, such as driving, walking up or down stairs, and using the bathroom. If you have BPPV, your doctor might prescribe a series of simple movements, called the Epley maneuver, to help dislodge the otoconia from the semicircular canal. You begin the Epley maneuver by sitting upright, with the help of a trained therapist, then quickly lie down on your back, turn your head to one side, and wait for a minute or two before sitting back up again (see Figure 3). For some people, one session will be all that is needed. Others might need to repeat the procedure several times at home to relieve their dizziness.
If you are diagnosed with Ménière's disease, your doctor may recommend changes in your diet, such as reducing the use of salt in your food and limiting alcohol and caffeine. Not smoking also may help. Some anti-vertigo or anti-nausea medications may relieve your symptoms, but they can also make you drowsy. Other medications, such as the antibiotic gentamicin or corticosteroids, may be injected behind the eardrum to reach the inner ear. Although gentamicin helps reduce dizziness, it occasionally destroys sensory cells in the cochlea and causes permanent hearing loss. The risk of hearing loss can be lowered if small doses of gentamicin are given off and on until your symptoms decrease. Corticosteroids don't cause hearing loss; however, research is underway to determine if they are as effective as gentamicin. Surgery on the vestibular organ may be necessary if you have a severe case of Ménière's disease.
Some people with a balance disorder may not be able to fully relieve their dizziness and will have to develop ways to cope with it on a daily basis. A vestibular rehabilitation therapist can help by developing an individualized treatment plan that combines head, body, and eye exercises to decrease dizziness and nausea.
To reduce your risk of injury from dizziness, avoid walking in the dark. You also should wear low-heeled shoes or walking shoes outdoors and use a cane or walker if necessary. If you have handrails in the home, inspect them periodically to make sure they are safe and secure. Modifications to bathroom fixtures can make them safer. Conditions at work may need to be modified or restricted, at least temporarily. Driving a car may be especially hazardous. Ask your doctor's opinion about whether it's safe for you to drive.
Reviewed on 9/23/2011
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