A balance disorder is a disorder that causes a person to feel unstable, such as standing or walking. It may be accompanied by feelings of dizziness, or wooziness, or have a motion sensation, spin, or float. Balance is the result of several body systems that work together: the visual system (eye), the vestibular system (ear) and proprioception (the feeling of the body in which it is in outer space). Degeneration or loss of function in one of these systems can cause a balance deficit.
Video Balance disorder
Signs and symptoms
When balance is disrupted, one has difficulty maintaining an upright orientation. For example, a person may not be able to walk without difficulty, or even can not stand. They may fall or almost fall. The symptoms may be recurrent or relatively constant. When there are symptoms, they may include:
- Sensation of dizziness or vertigo.
- Lightheadedness or feeling dizzy.
- Problem reading and hard to see.
- Disorientation.
Some individuals may also experience nausea and vomiting, diarrhea, fainting, heart rate changes and blood pressure, fear, anxiety, or panic. Some of the reactions to symptoms are fatigue, depression, and decreased concentration. Symptoms may appear and disappear within a short period of time or may last for a longer period.
Cognitive dysfunction (disorientation) may occur with vestibular disorders. Cognitive deficits are not only spatial, but also include non-spatial functions such as object recognition memories. Vestibular dysfunction has been shown to influence the attention process and increased attention demands can aggravate postural swings associated with vestibular disorders. Recent MRI studies also show that humans with bilateral vestibular damage experience hippocampal atrophy that correlates with the extent of damage to spatial memory tasks.
Maps Balance disorder
Cause
Problems with balance can occur when there is interference in one vestibular, visual, or proprioceptive system. Abnormalities in the balance function may indicate various pathologies from causes such as inner ear disorders, low blood pressure, brain tumors, and brain injury including stroke.
Many different terms are often used for dizziness, including dizziness, floating, dizziness, dizziness, confusion, helplessness, or blurring. Vertigo, Disequilibrium and pre-syncope are terms used by most doctors and have a more precise definition.
Vertigo
Vertigo is the sensation of spinning or making the room rotate about you. Most people find very disturbing vertigo and report associated nausea and vomiting.
Disequilibrium
Disequilibrium is a sensation of loss of balance, and is most often characterized by frequent falls in certain directions. This condition is not often associated with nausea or vomiting.
Presyncope
Pre-syncope is a mild feeling or just feeling faint. Syncope, on the contrary, actually fainted. Lack of circulatory system, such as low blood pressure, can cause dizziness when a person suddenly stands up.
Problems in the skeletal or visual system, such as arthritis or eye muscle imbalance, can also cause balance problems.
Hipofungsi Vestibular
The role of this reflex is to keep your vision steady as you move your head. Vestibular hypoplasia is most often unilateral, referring to only one ear affected, but it can be a much more debilitating bilateral. Symptoms are characterized by dizziness, vertigo, instability and balance problems.
Also known causes of Vestibular Migraine. Both Vestibular Hypofunction and Vestibular Migraines are caused by cell phone use. Too often used or started on todays screens on our mobile phones paired with unequal pair of eyes and balance. These symptoms include dizziness, stress, anxiety, headaches, and a slight feeling of depersonalization (not in the body). The recommended treatments include: meditation, acupuncture, omega 3 vitamins, and replacing TV or watching mobile phones with a stable visual activity such as reading
Related to ear
The causes of ear-related dizziness are often characterized by vertigo (spinning) and nausea. Nystagmus (blinking of eyes, associated with Vestibulo-ocular Reflex [VOR]) is often seen in patients with acute peripheral causes.
- Benign Paroxysmal Positional Vertigo (BPPV) - The most common cause of vertigo. It is usually described as a brief, intense spinning sensation that occurs when there is a change of head position with respect to gravity. A person may experience BPPV when rolling left or right, after waking up in the morning, or when looking for objects on a high shelf. The cause of BPPV is the presence of a normal but misplaced calcium crystal called otoconia, which is commonly found in utricle and saccule (otolith organs) and used to sense movement. If they fall from the utricle and become loose in the semicircular canals, they can distort the sense of movement and cause a mismatch between the actual head movement and the information sent to the brain by the inner ear, causing a spinning sensation.
- Labyrinthitis - Inner ear infection or inflammation that causes dizziness and hearing loss.
- Vestibular neuronitis - a vestibular nerve infection, generally viral, causes vertigo
- Cochlear Neuronitis - infection of the Cochlear nerve, commonly virus, causes sudden deafness but no vertigo
- Trauma - Injury to the skull can cause fractures or concussions in the balance organs. In both cases acute head injury will often lead to dizziness and loss of vestibular function suddenly.
- Surgical surgery on the lateral semicircular canal (LSC) is a rare complication that does not always cause cochlear damage. Vestibular symptoms are pronounced. Dizziness and instability usually last for several months and sometimes for a year or more.
- Disease MÃÆ' Â © niÃÆ'¨re - disturbance of the inner ear fluid balance that causes long-lasting vertigo episodes, fluctuating hearing loss, tinnitus (ringing or roaring), and fullness of sensation in the ears. The cause of the disease MÃÆ'Ã… © niÃÆ'¨re is unknown.
- Perilymph fistula - the leakage of the inner ear fluid from the inner ear. May occur after a head injury, surgery, physical activity or no known cause.
- Superior canal dehiscence syndrome - impaired balance and hearing caused by cracks in the temporal bone, leading to superior duct dysfunction.
- Bilateral vestibulopathy - a condition involving loss of inner ear balance function in both ears. It may be caused by certain antibiotics, anti-cancer, and other drugs or by chemicals such as solvents, heavy metals, etc., which are ototoxic; or by diseases such as syphilis or autoimmune disease; or any other cause. In addition, the function of the semicircular canal may be temporarily affected by a number of drugs or combinations of drugs.
Related to brain and central nervous system
Brain-related causes are less commonly associated with isolated vertigo and nystagmus but can still produce signs and symptoms, which resemble peripheral causes. Disequilibrium is often a prominent feature.
- Degenerative: age-related decrement in balance function
- Contagious: meningitis, encephalitis, epidural abscess, syphilis
- Circulatory: cerebral or cerebellar ischemia or hypoperfusion, stroke, lateral medullary syndrome (Wallenberg syndrome)
- Autoimmune: Cogan's syndrome
- Structural: Arnold-Chiari malformation, hydrocephalus
- Systemic: celiac disease, multiple sclerosis, Parkinson's disease
- Vitamin deficiency: Vitamin B12 deficiency
- CNS or posterior, benign or malignant neoplasms
- Neurologic: vertiginous epilepsy, abasia
- Others - There are a number of other causes of dizziness that are not related to the ear.
- Mal de debarquement is a rare imbalance disorder caused by being aboard. Patients suffering from this condition experience disequilibrium even when they get off the ship. Usually treatment for seasickness is not effective for this syndrome.
- Motion movements - conflicts between inputs from various systems involved in balance cause unpleasant sensations. For this reason, looking out the window of a moving car is much more fun than looking into a vehicle.
- Vertigo-related migraines
- Poison, drugs, drugs; it is also a symptom of carbon monoxide poisoning.
Pathophysiology
A semicircular canal, found in the vestibular apparatus, tell us when we are turning (circular). Semicircular channels are filled with liquid. Liquid motion tells us if we move. The vestibule is the inner ear region where the semicircular canal meets, close to the cochlea (auditory organ). The vestibular system works with visual systems to keep objects focused as the head moves. This is called the vestibulo-ocular reflex (VOR).
The fluid movement in the semicircular canal signals the brain about the direction and speed of the head rotation - for example, do we nod our heads up and down or look from right to left. Each semicircular canal has a bulging tip, or enlarged portion, that contains hair cells. The rotation of the head causes a fluid flow, which in turn causes the upper movement of hair cells embedded in the jelly-like cupula. Two other organs that are part of the vestibular system are utrikulus and saccule. This is called an otolytic organ and is responsible for detecting linear acceleration, or movement in a straight line. Hair cells from otolitic organs are covered with layers like jelly that are covered with small calcium stones called otoconia. When the head is tilted or the body position changes with respect to gravity, the movement of the stone causes the hair cells to bend.
The balance system works with visual and skeletal systems (muscles and joints and sensors) to maintain orientation or balance. For example, visual signals are sent to the brain about the position of the body in relation to its environment. These signals are processed by the brain, and compared with information from the vestibular, visual and skeletal systems.
Diagnosis
The difficulty of making a right vestibular diagnosis is reflected in the fact that in some populations, more than a third of patients with vestibular disease consult with more than one doctor - in some cases up to more than fifteen.
The diagnosis of a balance disorder is complicated because there are many types of balance disorders and because of other medical conditions - including ear infections, changes in blood pressure, and some vision problems - and some drugs can cause balance disorders. A person experiencing dizziness should see a physiotherapist or doctor for evaluation. A doctor may assess a medical disorder, such as a stroke or infection, if indicated. A physiotherapist can assess balance or dizziness and provide special care.
The primary doctor may seek the opinion of an otolaryngologist to help evaluate the balance problem. An otolaryngologist is a physician/surgeon specializing in diseases and disorders of the ear, nose, throat, head, and neck, sometimes with expertise in balance disorders. She will usually get a detailed medical history and do a physical exam to begin sorting out the possible causes of the balance disorder. The doctor may require tests and make additional references to assess the cause and extent of the disturbance of the balance. The type of tests required will vary based on the patient's symptoms and health status. Because there are so many variables, not all patients will need every test.
Diagnostic testing
Vestibular system (balance) function tests include electronystagmography (ENG), Videonystagmograph (VNG), rotation test, Dynamic Computerized Posture (CDP), and Caloric reflex test.
Hearing system test (auditory) functions include pure tone audiometry, speech audiometry, acoustic reflex, electrocochleography (ECoG), otoacoustic emission (OAE), and auditory brain stem response test (ABR, also known as BER, BSER, or BAER).
Other diagnostic tests include magnetic resonance imaging (MRI) and a computerized axial tomography (CAT, or CT).
Treatment
There are various options for treating disorder balance. One option includes treatment for diseases or disorders that may contribute to a balance problem, such as ear infections, stroke, multiple sclerosis, spinal cord injury, Parkinson's, neuromuscular conditions, acquired brain injury, cerebellar dysfunction and/or ataxia, or multiple tumors, such as acoustic neuroma. Personal care will vary and will be based on assessment results including symptoms, medical history, general health, and medical test results. In addition, tai chi may be a cost-effective method of preventing falls in the elderly.
Vestibular Rehabilitation
Many types of balance disorders will require balance training, which is determined by occupational therapists or physiotherapists. Physiotherapists often set out standardized outcome measures as part of their assessment to obtain useful information and data on current patient status. Several standardized outcome measures or outcome measures include but are not limited to Functional Reach Tests, Clinical Trial for Sensory Integration in Balance (CTSIB), Berg Balance Scale and/or Time and Go Data and information gathered may further assist the developing physiotherapist. an intervention program specifically for the assessed individual. The intervention program may include training activities that can be used to improve postural static and dynamic control, body alignment, weight distribution, ambulation, fall prevention and sensory function. Although there are treatment programs that seek to assist the brain in adapting to vestibular injury, it is important to note that it is just that - an adaptation to injury. Even though the patient's balance recovers, a balance system injury is still present.
BPPV
Benign Paroxysmal Positional Vertigo (BPPV) is caused by misplaced crystals in the ear. Treatment, simply, involves removing these crystals out of the area causing vertigo and to the area where they are not. A number of exercises have been developed to shift these crystals. The following article explains with a diagram how these exercises can be done in the office or at home with the help of: The success of these exercises depends on those being done right.
The two exercises described in the article above are:
- Brandt-Daroff Training, which can be done at home and has a very high but unpleasant and time-consuming level of success to perform.
- Epley exercises are often performed by doctors or other trained professionals and should not be done at home. A variety of devices are available for home BPPV treatment.
Diseases MÃÆ' Â © niÃÆ'¨ re
- Diet: Dietary changes such as reducing sodium intake (salt) may help. For some people, reducing alcohol, caffeine, and/or avoiding nicotine can help. Stress has also been shown to make the symptoms associated with MÃÆ'Â Â © niÃÆ'¨re worse.
- Drugs:
- Beta-histine (Serc) is available in some countries and is thought to reduce the frequency of symptoms
- Diuretics such as hydrochlorothiazide (Diazide) have also been shown to reduce the frequency of symptoms
- Aminoglycoside antibiotics (gentamicin) can be used to treat MÃÆ' Â © niÃÆ'¨re disease. Systemic streptomycin (given by injection) and topical gentamicin (given directly to the inner ear) are useful for their ability to affect hair cells in the balance system. Gentamicin may also affect cochlear hair cells, though, and cause hearing loss in about 10% of patients. In cases that do not respond to medical management, surgery may be indicated.
- Surgery for illness MÃÆ' Â © niÃÆ'¨re is the last resort.
- Vestibular neuronectomy can cure MÃÆ' Â © niÃÆ'¨re disease but it involves extensive surgery and is not widely available. It involves drilling into the skull and cutting off the nerve balance just as it will enter the brain.
- Labyrinthectomy (surgical removal of all the balance organs) is more available as a treatment but causes total hearing in the affected ear.
Labyrinthitis
Treatment includes exercise balance training (vestibular rehabilitation). Exercises include head and body movements specifically developed for the patient. This form of therapy is thought to promote habituation, adaptation of the vestibulo-ocular reflex, and/or sensory substitution. The vestibular retraining program is administered by professionals with knowledge and understanding of the vestibular system and its relationship to other systems in the body.
Bilateral vestibular loss
Dylilibrium arising from loss of bilateral vestibular function - as can occur from ototoxic drugs such as gentamicin - can also be treated with retraining retraining exercises (vestibular rehabilitation) although improvement is unlikely to be full recovery.
Medication
Sedatives are often prescribed for vertigo and dizziness, but these usually treat symptoms rather than underlying causes. Lorazepam (Ativan) is often used and is a sedative that has no effect on the disease process, but rather helps the patient overcome the sensation.
Anti-nausea, as prescribed for motion sickness, is also often prescribed but does not affect the prognosis of the disorder.
Especially for Meniere's disease, a drug called Serc (Beta-histine) is available. There is some evidence to support its effectiveness in reducing the frequency of attacks. Also Diuretics, such as Diazide (HCTZ/triamterene), are effective in many patients. Finally, ototoxic drugs delivered either systemically or through the eardrum can eliminate Meniere-related vertigo in most cases, although there is about 10% risk of further hearing loss when using ototoxic drugs.
Special care for the underlying disturbance disorder:
- anticholinergic
- antihistamines
- benzodiazepines
- calcium channel antagonists, especially Verapamil and Nimodipine
- GABA modulators, especially gabapentin and baclofen
- Neurotransmitter reuptake inhibitors such as SSRI, SNRI and Tricyclics
Research
Scientists at the National Institute on Deafness and Other Communication Disorders (NIDCD) work to understand the various disorders of balance and complex interactions between the labyrinth, other balance-regulating organs, and the brain. NIDCD scientists study eye movements to understand the changes that occur in aging, disease, and injury, as well as collect data on eye movement and posture to improve the diagnosis and treatment of balance disorders. They also study the effectiveness of certain exercises as a treatment option.
Other projects supported by NIDCD include the study of genes essential for normal development and function in the vestibular system. NIDCD scientists also study brain-derived syndromes that affect balance and coordination.
NIDCD supports research to develop new tests and improve the current balance test and vestibular function. For example, NIDCD scientists have developed computer-controlled systems to measure eye movement and body position by stimulating certain parts of the vestibular system and the nervous system. Other tests to determine disability, as well as a new physical rehabilitation strategy, are being investigated in clinical and research settings.
Scientists at NIDCD hope that the new data will help develop strategies to prevent injuries from falling, a common occurrence among people with impaired balance, especially as they grow older.
References
Further reading
- O'Reilly, Robert (2013). Pediatric Balance Disorder Manual . San Diego, Plural Publishing, Inc.
- Jacobson, Gary; Shepard, Neil (2008). Assessment of Balance and Management Functions . San Diego, Plural Publishing, Inc. Ã,
www.earandbalance.net/
External links
- National Institutes of Health - dizziness and vertigo
- The British Tinnitus Association - Balance and Tinnitus
Source of the article : Wikipedia
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