| Diagnosis & Treatment |
Dizziness and balance disorders are common and can affect people of any age, gender, race, or socioeconomic group. The symptoms may include whirling dizziness, unsteadiness or imbalance when walking, and nausea. These symptoms may be mild, lasting only minutes, or severe, resulting in total disability.
- It is estimated that there are between 5 and 8 million physician visits for dizziness in the United States each year, and dizziness is the leading reason for a physician visit for patients over age 75 years.
- In the United States the cost of medical care for patients with balance disorders is estimated to exceed $1 billion per year.
- Over 450,000 persons (primarily between the ages of 15-24 years) suffer head injuries annually; 79% of those patients hospitalized for two days or less, with a "completely normal" neurological examination, will experience dizziness within three months. The majority of serious head injury patients will complain of dizziness for up to five years following injury and many are disabled by this symptom. Complaints of dizziness and unsteadiness are frequent problems in accidental and job-related mild head injuries.
- Every year, one-third to one-half of the population age 65 and over experience falls. Of all falls suffered by the elderly, 50% are the result of vestibular problems. Half of the elderly people who fall do so repeatedly. Falls are the leading cause of injury in older adults and are the leading cause of death in those over age 85. Five percent of falls lead to bone fracture, resulting in approximately 300,000 hip fractures annually, with an estimated cost of $20.2 million for the treatment of fall-related injuries. Although 25% of hip fracture patients make a full recovery, 40% will require nursing home admission, 50% will require a cane or walker and 20% will die.
Some balance disorders are related to a problem in the inner ear, while others are the result of other health problems or diseases. The diagnosis and management of balance and vestibular disorders can be challenging since the normal processes involved in the control of balance and equilibrium are the result of complicated interactions of several senses and systems of the body. These systems include the inner ear, vision, and touch, as well as the parts of the brain that interpret and coordinate the information coming from these areas.
The balance system detects the position and movement of the head in three-dimensional space. This system developed to assist with movement, and as a result, functions to coordinate reflexes for:
- balance during walking as well as the detection of position and movement of the head;
- posture necessary for quiet stance, requiring connections with the so-called "anti-gravity" muscles; and
- gaze to assist in stabilizing visual images, despite movement of the observer, the object, or both.
The inner ear balance apparatus consists of two types of structures: the semicircular canals, and the otolith organs, which detect head position and head movement in any direction. Information from these sensors ultimately is used to generate eye movement reflexes for clear vision when the head moves, or spinal reflexes for balance and posture.
| Testing Capabilities |
The highly trained personnel at the University of Virginia Medical Center have a long-standing history of providing state-of-the-art evaluation and management of patients with dizziness and balance disorders. The professional expertise of the staff along with the testing facilities available at the Vestibular and Balance Center position this clinic as one of the leading resources on the East Coast for patients with balance problems.
The tests of balance function used most often include rotary chair testing and electronystagmography (ENG). These tests provide information regarding the origin (i.e., inner ear vs. elsewhere) and extent (i.e., one ear vs. both ears) of balance system disturbance evident in eye movement reflexes. In addition, Dynamic Posturography, a more recently developed procedure, examines the relative contributions of inner ear, visual, and touch information evident in spinal reflexes in the control and maintenance of balance and posture.
- Rotary chair testing consists of eye movement recordings made during and after rotational stimulation. The rotational stimulation can be either to and fro or sustained in one direction, resulting in the production of characteristic eye movements, which are utilized to determine overall responsiveness and symmetric function of the inner ear balance structures.
- The ENG is comprised of tests of eye movements, positional maneuvers of the head and body, and stimulation of the inner ear structures that detect head movement. Eye movement recordings are made for various visual targets in order to determine the effectiveness of the system that moves the eyes. By placing the head in various positions, the positional maneuvers assess the effects of gravitational forces on the balance sensors. The eye movements resulting from stimulation are assessed for symmetry and direction in order to distinguish weakness of function in one or both ears.
- In Dynamic Posturography the spinal reflexes necessary for balance and posture are assessed by use of a force detector incorporated into the surface upon which the patient stands during the evaluation. The patient attempts to maintain quiet stance as visual and other cues that contribute to balance and posture are manipulated in order to determine the coordination of information from the inner ear balance system, vision, and the sense of touch.
| For More Information |
For more information about the UVA Vestibular and Balance Center, contact
A. Tucker Gleason, PhD, Director, at (434) 924-2050, Fax (434) 982-0700 or email: atg2v@virginia.edu
The following links may also provide additional information on vestibular and balance disorders: