Here’s a quick test to see if your occasional dizzy spells may be something more than a minor issue: Stand up and close your eyes. If you sway or stumble, your dizziness may have a serious cause.
While it can be attributed to neurological problems in your legs (often from diabetes), it’s more likely to be something called a vestibular disorder. According to a recent epidemiological study, the disorders affect as many as 35 percent of adults aged 40 years or older in the U.S. “” approximately 69 million Americans “” and account for a third of all patient complaints of dizziness and vertigo. They’re the most cited reason for balance problems in patients 70 and older.
What are vestibular disorders?
Vestibular disorders occur when disease or injury disturb parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. It often leads to a spinning sensation or an illusion that everything is moving around you (vertigo) and dizziness along with balance problems, nausea, headaches, hearing loss or a feeling of pain or fullness in the ears.
The above test can be a good indication that you’re suffering from an inner ear disorder, according to Scott Schowalter, a physical therapist with St. Elizabeth who has been working with vestibular disorder patients for years.
“We have three systems that help with our balance: Sight, sensation and the inner ear. You can manage pretty well with two of the three, but if you remove two from the process, the effects are pronounced,” he said.
Falling ear crystals
The most common cause is called benign paroxysmal positional vertigo (BPPV), in which otoconia — tiny crystals of calcium carbonate that are a normal part of the inner ear’s anatomy — become dislodged and find their way into another one of the inner ear’s semicircular canals. The crystals, when in their correct place, help detect head movements.
When they become dislodged and settle in another canal, however, they send false signals to the brain producing vertigo and involuntary eye movements called nystagmus.
Schowalter said those eye movements are a key to diagnosis. Patients referred to him typically use a set of goggles that record video close-ups of their eyes as Schowalter leads them through a series of head movements.
The way patients’ eyes move during these movements reveal if the patient has BPPV and, if so, how best to treat it through physical therapy.
“Each canal assists a certain set of eye muscles. The direction those muscles causes your eyes to move tells me where the crystals are, and what we need to do to get them positioned correctly again,” said Schowalter.
“It was awful. ” I just went straight to the ER”
The treatment can be amazingly simple, as one patient, discovered recently.
Jason Wessel, who serves as St. Elizabeth’s Assistant Vice President of Patient Care Services, found himself in Schowalter’s care. Last year, after suffering from dizziness for a few weeks, he began to suspect he’d suffered a stroke.
“It was awful and getting progressively worse. You can’t imagine the way it affects your life, but you think it’ll pass. I was in the office one day and it got so bad, I just went straight over to the ER,” Wessel said.
He was quickly diagnosed as having BPPV and referred to Schowalter. After one session, Wessel says he was almost back to normal. A second therapy session days later got him the rest of the way.
According to Schowalter, quick cures for BPPV are common. Statistically, there is a 70 percent success rate with just one treatment. After a second treatment, it’s around a 95 percent success rate.
“For some people, it takes a few treatments, but for others it’s one-and-done,” he said.
Other causes of vestibular problems, ranging from infections like labyrinthitis, abnormalities in the fluid within the inner ear’s organs, or trauma-induced problems like a perilymph fistula (a tear in inner ear membranes), may involve more treatment but some are not difficult to relieve, according to Schowalter.
“For many types of vestibular problems, we can help patients retrain their brain to focus their vision or lessen the effects of dizziness,” he said. “They can return to their normal lives.”
New local resources help sufferers to quick cures
An aging population in which balance problems can lead to more injuries due to falls is one reason St. Elizabeth has expanded training for vestibular disorders to include 12 additional physical therapists and physical therapist assistants, all certified in vestibular rehabilitation by the American Institute of Balance. Many are already being helped now by the expansion of this program.
“There was a perception, I think, that there wasn’t a lot you could do about it. It was just assumed it was part of aging,” says Dr. James J. Kempiners with ENT & Allergy Specialists, a St. Elizabeth physician collaborator.
“Doctors didn’t have an X-ray that would show it, there is no blood test, so they don’t necessarily know what to do with these patients after other causes have been ruled out. I’ve had patients tell me they were diagnosed with vertigo. That’s not a diagnosis, any more than saying you’ve been diagnosed with a chronic cough. It’s a symptom. The trick is finding out what’s causing it, then we can treat it.”
If you think you or someone you love is experiencing this type of problem, talked to your primary care provider about a referral to an ear, nose and throat specialist, who can confirm this diagnosis and prescribe physical therapy.
You can read up on vestibular disorders at the American Institute of Balance. ENT & Allergy Specialists in Ft. Thomas has also set up a patient hotline – (859) 344-4456 ““ to answer questions about vestibular disorders and get patients in touch with doctors. To schedule an appointment with a physical therapist at St. Elizabeth, call 877-424-5750.
