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Dizziness and Balance Problems- How to Prevent Falls
By: Gita Mikal, Certified Vestibular Physiotherapist
Dizziness is among some of the most commonly reported symptoms by older adults during their visits to doctors. It can be triggered a myriad of reasons. Essentially, it can be a symptom of an underlying vestibular or neurological disorder. In addition to inner ear problems, there are several other possible causes for dizziness.
What triggers your dizziness and how it affects your balance can help in diagnosing the possible causes. In many conditions, there are many laboratory tests that can help in finding the cause of the problem. In most dizziness cases, there are no laboratory test that can give knowledge to the cause therefore, most of the diagnosis is relied on patient’s report such as the length of the dizzy spell and other associated symptom. This information helps to narrow down the list of possible causes.
Most cases of acute dizziness are treatable and often pass without any recurrence. While each individual is affected by the symptoms differently, a more severe case of persistent dizziness specially when other symptoms such as loss of sensation in one side of body, slurred speech and double vision are present, you need to visit to ER.
While dizziness is most commonly described as a feeling of being light headed, people have reported different experiences. For instance, some people use the term to define feeling unsteady or off-balance, while some use it to describe the feeling of spinning surroundings (vertigo).
Some of the common symptoms associated with dizziness include feeling like one is about to faint, disequilibrium, feeling of floating, a false sense of motion or vertigo, or feeling heavy-headed. These symptoms may or may not be accompanied by nausea or vomiting and a feeling of disorientation.
In most cases, the symptoms disappear naturally over a period of time. However, symptoms may not completely disappear in short period of time. Patient, may continue to experience episodes of short lasting dizziness or vertigo. Concentrating while doing daily tasks or even watching a TV or reading a book can become troublesome. Some patients report difficulty with standing up straight for an extended amount of time and trying to move on an uneven surface.
Dizziness vs. Vertigo
People often get confused and refer to dizziness and vertigo as the same. While both are sensations as the result of a condition or disorder, they are slightly different from each other. Vertigo is a false feeling of motion around your periphery that creates a sensation of movement and spinning of the surroundings. It is usually caused by disorders of the vestibular system or the balance organs located in inner ear.
Meanwhile, dizziness is a feeling of being light headed or feeling faintness that can also be accompanied with vertigo. Vertigo can sometimes last longer and debilitate the individual as it is debilitating and affects daily life and work. Vertigo and dizziness can be triggered by the same condition which can be the cause disequilibrium.
1. Vestibular (inner ear cause)
Approximately 80-85 percent of people reporting dizziness suffer from inner-ear problems. They can be caused by accidents, injuries, inflammation, bacterial or viral infections. When the dysfunctions are related to the balance organs in the ears or in the nerves outside of central nervous system, they are called peripheral vestibular disorders.
- Menier’s Disease – This disorder is associated with an excessive buildup of fluid in the inner ear. This causes vertigo spells along with a ringing in ear or a feeling of having a plugged ear. A distinctive sign is usually gradual hearing loss.
- Benign Paroxysmal Positional Vertigo (BPPV) – It occurs when the calcium particls in the inner ear get dislodged from their usual positions and start floating in vestibular canals. Since they are responsible for stimulating the nerves located in the inner ear to send signals to brain to maintain your balance, they send mixed signals to the brain which creates that sense of dizziness.
- Vestibular Neuritis – This is an inflammation that is caused by a virus in the vestibular nerve serving the vestibular system in inner ear. It often causes intense vertigo that lasts for an extended time period.
- Labyrinthitis – This is an advanced form of Vestibular Neuritis that may lead to a sudden hearing loss in addition to vertigo.
- Vestibular Schwannoma – This is a benign form of a primary intracranial tumor of the vestibulocochlear nerve and affects hearing and balance. Vestibular Schwannoma is a rare cause of dizziness.
- Ramsay Hunt Disease – This condition consists of a shingles-like infection affecting the vestibular nerves near the inner-ear and causes severe dizziness.
- Vestibular Migraine – These headaches are one of the common causes of dizziness and vertigo.
Neurological conditions that cause autoimmune disorders can often cause progressive loss of balance with a sense of dizziness. These disorders like Parkinson’s and Multiple Sclerosis attack the myelin sheath of neurons and interrupt neurotransmission, causing various symptoms.
3. Circulation Problems
When the heart doesn’t pump sufficient blood to the brain, it decreases the amount of oxygen in your blood. This can make people feel dizzy and off-balance and can also cause them to faint. The causes of this include:
- Low Blood Pressure – Also called Orthostatic Hypotension, a sudden drop in the systolic blood pressure can cause dizziness or feeling light headed usually with standing.
- Poor Circulation – As a result of disorders like cardiomyopathy, arrhythmia, and transient ischemic attack can disrupt blood circulation can cause dizziness.
- Low Blood Volume – Disorders like anemia and low hemoglobin can decrease blood volume and lower blood flow to the brain and inner ear, causing dizziness.
Various types of medication cause complex reaction with the body’s metabolism. Dizziness and vertigo can sometimes be one of the side-effects caused as a result of these reactions. Some strong antibiotics, anti-convulsion medications, antidepressants, sedatives, pain relief, and blood pressure medicine can cause dizziness.
Besides these main causes, dizziness can also be triggered by:
- Anxiety disorders
- Low blood sugar levels
- Dehydration which is commonly a reason for dizziness in elderly
Your balance or equilibrium function is managed by the brain. It receives accurate critical information through nerves receiving signals from the neurons in different sensory organs. The signals sent from these neurons are then transmitted to the cerebellum, which is responsible for maintaining balance.
Your vestibular system (located in the inner ear), visual system, somatosensory system (receptors in skin and muscles of the ankle and lower leg), and the central nervous system (brain and spinal cord) all work together to contribute information to the brain to maintain the body’s balance.
If the messages are lost in transmission due to a disease, the cerebellum misreads those signals and causes balance problems. These balance issues can make you feel lightheaded, faint, dizzy, and unsteady. They can also cause vertigo, which can feel like the room is spinning. These symptoms can occur even when you are sitting or lying down.
While there are several medical conditions that can cause balance problems, most cases are caused by a disorder or issue in the vestibular system. These disorders are treatable and can solve various balance issues.
In summary, since the loss of balance is a combination of vertigo, dizziness, and unsteadiness, the majority of their causes can also lead to balance problems. Most of these disorders are associated with the vestibular system including the following:
- Minier’s Disease
- Benign Paroxysmal Positional Vertigo
- Vestibular Neuritis
- Ramsay Hunt Disease
- Persistent Postural-Perceptual Dizziness
Besides these vestibular disorders and disturbances, balance problems can also be caused by:
- Motion Sickness
- Head Injuries
- Orthostatic Hypotension
- Cardiovascular disorders
- Musculoskeletal Problems
- Vision Problems
- Peripheral Neuropathy
Balance problems can also be caused by different neurological conditions, lower extremity and postural and core muscle weakness. Diseases like Parkinson’s, Multiple Sclerosis in conditions that affect transmission of neural signals, mechanical conditions such as cervical spondylosis when there is pressure on the blood supply can also cause dizziness . In such disease or conditions, where the neurons suffer damage, there can be delays in neurotransmission, triggering various kinds of symptoms including loss of balance.
When to See a Physiotherapist or Doctor
While most symptoms of dizziness, vertigo and imbalance subside naturally on their own, they can sometimes last longer. If your dizziness or disequilibrium is triggered by a more serious underlying condition, you need to consult a doctor.
If you are a diabetic, check your blood sugar levels. Sometimes low blood sugar can cause dizziness and vertigo. If it is low, try to eat a fruit or something sweet.
See you doctor if the symptoms don’t subside in a few hours or you experience sudden, severe and unexplained dizziness. You should also seek immediate help if your dizziness or imbalance is accompanied by:
- Chest pain
- Numbness in limbs
- Prolonged vomiting
- Slurred speech
- Loss of hearing or sight
- Facial numbness
- Severe shortness of breath
Addressing Balance Problems
It is imperative that you address these symptoms and seek help. If you ignore them and let them affect you for an extended amount of time, they can worsen and become more intense. Many people can take their body’s ability to balance for granted and end up creating more trouble than necessary.
Dizziness and balance problems increase the risk of falling down and sustaining an injury. They can prove even more hazardous if you are driving a car, operating machinery or lifting something heavy. You are more likely to trigger worsening symptoms and experience an incident, if you don’t address your balance and dizziness.
The Center for Disease Control (CDC) has published reports that say one in five falls lead to a more serious injury. This includes broken bones, fractures, and head injuries. These injuries can cause long-lasting and even permanent implications and reduce the quality of life for the individual.
The need to treat dizziness and imbalance becomes even more critical for elderly people. As people age, their bones and joints wear down and become more fragile. Also, their body’s propensity to recover from injuries diminishes to a great degree. This is the reason why elderly people are more likely to break a bone as a result of a fall, often requiring invasive surgeries.
Leaving dizziness untreated can also affect other brain functions. For instance, many people feel confused, are unable to think straight or keep their eyes focused. This is because the brain exerts all efforts into keeping your body upright, lowering the effort on other functions.
Treating the dizziness and disequilibrium is the first step in preventing falls and fractures. A trained physiotherapist and medical doctor will be able to find the root cause of the dizziness and proceed with the appropriate course of treatment.
Working Wonders – Vestibular and Neurological Physiotherapy
Over the years, vestibular and neurological physiotherapy has proven to be very effective in reducing dizziness and imbalance. Both therapies are designed to retrain the brain with exercise to improve the overall quality of life.
Vestibular Physiotherapy or Rehabilitation
Vestibular physiotherapy is practiced based on the theory that we can train our brain to relieve dizziness and imbalance symptoms. By doing repeated movements and sending the cerebellum proper signals, we can teach our brain to adapt to those signals and reinterpret them in a way that causes less dizziness. With that, the brain gets used to various movements, causing the symptoms to subside.
The therapy includes exercise regimens unique to the individual’s cause of dizziness. The regimens include gaze stabilization, balance training, head movement, involuntary eye movements, and other exercises. These exercises stimulate the nerves in the inner ear and the labyrinth, which is a 3-semicircular-canal structure surrounded by fluid. It transmits signals to the cerebellum, which controls the body’s balance and motor activity. These exercises can also help the brain learn how to compensate for any lost senses if the vestibular organs suffer significant damage.
Various studies have shown that 30 percent of people can recover completely with vestibular physiotherapy, while 85% can find partial relief. This makes the therapy effective for a wide range of people.
Neurological Physiotherapy or Rehabilitation
Neurological physiotherapy is another form of non-invasive, drug-free treatment for dizziness and imbalance. It is designed for those who suffer dizziness as a result of a neurological disorder such as MS or Parkinson’s.
These disorders can seriously lower the patient’s quality of life. It can reduce mobility, cause weakness in muscles, and disequilibrium. This increases the risk of falls and broken bones along with other serious complications.
Neurological physiology is designed to stimulate the nervous system with exercise, movement and mobility aids. Each exercise is targeted to improve coordination, strength and cardiovascular function to reduce the impact of the neurological disorder.
Regardless of whether the dizziness is caused by a vestibular disorder or neurological dysfunction, what matters is that you treat it before it gets worse. So contact your local vestibular physiotherapist and raise concern regarding your dizziness. With proper care and treatment, you can gain your balance back and improve your quality of life.