Balance disorders (Vertigo - Instability - Dizziness)

What is balance?

Balance is the ability to sustain an upright posture and stable position. With proper function of the balance system we can

  • recognize the position of our body in space

  • orient ourselves

  • recognize where we are in relation to gravity

  • recognize the speed of movement

  • be able to track a moving target

Balance mechanism

Balance is achieved and maintained by a complex set of sensorimotor control systems. Balance system receives information from

  • the vestibular system (motion, balance, spatial orientation)

  • from vision (eyes)

  • proprioception (touch, joints, muscles)

Symptoms associated with balance disorders

The most common reason to visit an otolaryngologist is one of the following symptoms, which should be distinguished.

Dizziness - vertigo - unsteadiness

IMPORTANT: These are completely different symptoms and they must be specified which is your symptom

  • Dizziness: this is a fairly general term and includes a wide range of symptoms such as feeling faint, feeling weak or unable to support one side

  • Vertigo : vertigo is a symptom in which the affected person has the sensation that space is spinning or the person feels that they are spinning around space

  • Instability (Unsteadiness): the lack of stability, usually during movement, but not associated with a feeling of rotation

What does the test for balance disorders include?

First of all the procedure involves a very detailed history and clinical examination which includes some postural and movement tests.

Then audiological evaluation is necessary. In the case of benign positional vertigo, repositioning with special manipulations is done in the clinic but there are cases in which further investigation is needed :

  • imaging tests (e.g. MRI)

  • special balance tests such as videonystagmography, vHIT, cVEMP, oVEMP, etc.

  • cooperation with doctors of other specialties who can contribute to the diagnosis eg neurologist

Medical History

Clinical Examonation

Audiological Test Blood test and imaging might be required

Questinnaires

Differential diagnosis

Other conditions associated with dizziness or instability involving cardiovascular disease, neurological disease and systemic disease or autoimmunity should be excluded.

Cardiovascular diseases

(eg orthostatic hypotension)

Neurological diseases

(eg multiple sclerosis)

Other / systematic

(eg autoimmune)

Balance disorders associated with otolaryngological diseases

Benign paroxysmal positional vertigo (BPPV) - Most common cause of vertigo

  • Vestibular migraine

  • Labyrinthitis

  • Vestibular neuritis

  • Meniere's disease

  • Age-related dizziness and imbalance

  • Head injury concussion or TBI

Rare conditions:

  • Perilymphatic fistula

  • acoustic neuroma (vestibular schwannoma)

  • Mal de débarquement: a feeling of rocking or movement that persists after a sea cruise or other form of travel.

  • Bilateral vestibular hypofunction

  • Ototoxicity

  • Neurotoxicity affecting the vestibular system

  • Enlargement of vestibular aqueduct

  • Autoimmune

  • Secondary endolymphatic hydrops

  • Cholesteatoma

  • Persistent Postural Perceptual Dizziness (PPPD)

  • Psychological factors

What should the person suffering from balance disorders expect during /after the visit to the clinic?

  • Diagnosis or most likely diagnosis and treatment options

  • Instructions to be given

  • Relief from balance disorders depends on the diagnosis. If it is paroxysmal positional vertigo (BPPV), the rehabilitation/ result is immediate and performed with special manipulations during the visit in the clinic.However, there are cases where rehabilitation may take even months or where there are flare-ups and remissions of the pathology.

  • Referral and cooperation with other specialties if necessary, e.g. neurologists

  • Good cooperation between the practitioner and the patient is of great importance for the outcome

  • Individual effort under guidance is a helpful way of coping with the symptoms and it may be necessary a referral to other health specialists such as physiotherapists or psychologists

Dr Katerina Vardonikolaki

MD, PhD, Otolaryngologist (ENT)

Certified Doctor by Performing Arts Medicine Association

© Αll rights reserved Κ.Vardonikolaki

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