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1993-09-02
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M-2: Vestibular Disorders:
What Are They?
The vestibular system is the part of the
inner ear and the brain that helps control
balance and eye movements. When the
inner ear or the brain are damaged by
disease or injury, vestibular disorders can
result.
The most commonly diagnosed vestibular
disorders include positional vertigo (also
called BPPV, BPPN, or BPV), Meniere's
disease, infections of the inner ear (called
labyrinthitis or vestibular neuronitis),
injury caused by head blows (called inner
ear concussion syndrome), endolymphatic
hydrops, and perilymph fistula.
Other, rarer disorders include slow-
growing tumors on the vestibular nerve
(called acoustic neuromas) and vestibular
disorders associated with allergic or
autoimmune disorders.
What Are the Symptoms of
Vestibular Disorders?
The most frequently reported symptoms of
vestibular disorders are dizziness,
unsteadiness or imbalance when walking,
vertigo, and nausea. These symptoms may
be quite mild, lasting minutes, or quite
severe, resulting in total disability.
Because the vestibular system interacts
with many other parts of the nervous
system, symptoms may also be experienced
as problems with vision, muscles, and
thinking, and memory.
In addition, people with vestibular
disorders may suffer headache and
muscular aches in the neck and back,
increased tendency to suffer from motion
sickness, and increased sensitivity to noise
and bright lights. Patients with vestibular
disorders often report fatigue and loss of
stamina and an inability to concentrate.
Difficulty with reading and speech may
occur during times of fatigue. When these
symptoms are constant and disabling, they
may be accompanied by irritability, loss of
self-esteem, and/or depression.
Who Is at Risk?
Vestibular disorders occur frequently and
can affect people of all ages and all walks
of life.
According to studies from the National
Institutes of Health, 90 million Americans
(42% of the population) will complain to
their doctors of dizziness at least once in
their lifetime. In 76 million of these
people, the cause of the problem will lie
in the inner ear.
The National Ambulatory Medical Care
Study (1988) found that in 1985 alone,
5,267,000 Americans sought medical help
for dizziness. An estimated half million of
these patients were severely disabled by
their symptoms.
The full cost of vestibular disorders to
society in terms of medical expenses and
lost productivity is still unknown.
What Causes Vestibular Disorders?
Blows to the head and whiplash are a
frequent cause of vestibular disorders in
people under age 50.
Ear infections such as otitis media and
inflammation of the inner ear
(labyrinthitis) may also cause damage to
the vestibular and hearing structures of
the inner ear.
Viruses may cause some vestibular
disorders.
High doses or long-term use of certain
antibiotics can also cause permanent
damage to the inner ear. Other drugs,
such as aspirin, caffeine, alcohol, nicotine,
sedatives, and tranquilizers, as well as
many illegal drugs, can cause temporary
dizziness but do not result in permanent
damage to the vestibular system.
If the flow of blood to the inner ear or the
brain is reduced or blocked (as in the case
of a stroke), damage to the vestibular
system can result.
Rarely, a slow-growing tumor on the nerve
that leads from the inner ear to the brain
(an acoustic neuroma) may interfere with
the normal function of the vestibular
system.
Finally, the causes of some vestibular
disorders remain a mystery.
How Are Vestibular Disorders Diagnosed?
Tests developed since 1984 enable
physicians to diagnose some vestibular
disorders that previously could not be
documented. Modern diagnostic
techniques for vestibular disorders rely on
a combination of tests and a careful
history of the problem.
First, a complete physical examination to
rule out other causes of dizziness such as
cardiovascular or central nervous system
disorders must be done.
Then, the patient will be referred to a
specialist (an otolaryngologist or neuro-
otologist) for vestibular testing.
Because the vestibular system is in close
proximity to the hearing apparatus,
vestibular testing includes hearing tests.
Eye movements often hold clues to
vestibular dysfunction. To record eye
movements, physicians use a technique
called electronystagmography (ENG).
In ENG testing, electrodes are put on the
facial muscles that control eye movement.
The patient is then placed in a variety of
situations, and the eye movements are
electronically recorded.
Balance is an essential component of
vestibular functioning. During balance
testing, patients may be asked to stand on
special platforms that record the
movement of the body. This kind of
testing is called moving platform
posturography.
How Are Vestibular Disorders Treated?
Treatment for vestibular disorders varies
according to the diagnosis. What works in
one case could make matters worse in
another.
In mild cases, the symptoms may go away
on their own as the vestibular apparatus
heals or the nervous system learns to
compensate for the disorder.
Where symptoms persist, some patients
can be cured completely. In other
persistent cases, the symptoms can only be
controlled and not eliminated entirely.
Treatments may consist of drugs, diets,
physical therapy, or in severe cases,
surgery.
What If I'm Disabled?
Although most vestibular disorders are
treatable, some people with the disorders
find they are temporarily or permanently
unable to work or carry on normal
activities.
Social Security disability as well as many
employee disability plans cover chronic,
severe disability caused by vestibular
disorders.
Such disability payments can be received
only if physicians attest to the disabling
effects of the disorder.
Records of medical exams and physician
visits will help in determining the
existence of a disability. Patients will often
be asked to see specific physicians for
examinations. Persistence and
attentiveness to fulfilling all the official
requirements is important.
It is often useful to have a care giver,
social worker, or friend help with the
record-keeping and paperwork.
Where Can People with Vestibular
Disorders Get Help?
Anyone troubled by symptoms of dizziness
or imbalance should see his or her regular
doctor first. If vestibular disorders are
suspected, the family physician or the
Vestibular Disorders Association can
recommend physicians who specialize in
diseases of the inner ear and who can
perform the necessary tests.
Vestibular disorders can be as mild as the
momentary imbalance you feel when you
get off a whirling carnival ride. However,
they can also be disruptive and
debilitating.
If you or someone you know is suffering
from a vestibular disorder, you can find
help.
The Vestibular Disorders Association is
dedicated to helping you find
knowledgeable physicians, to distributing
information about these disorders, and to
providing videotapes, booklets, a quarterly
newsletter, and other materials to enable
you to cope with your symptoms.
This document is not intended as a
substitute for professional health care.