A Matter of Balance

While falls are normal for infants learning to walk, falls are one of the most serious health hazards seniors face, and they often occur as a result of balance disorders. According to otolaryngologist, Dr. Joseph Motto, patients often present complaints of dizziness. “This is very subjective, and you must find out what they mean by dizziness. The most common type of disorder I see in older patients is syncope (fainting) associated with cardiovascular disorders,” he says.
Balance Disorders Among Older Adults
By Charlotte Boatwright, RN, PH.D.
Persons with balance disorders may complain of feeling woozy or disoriented and have sensations of falling, spinning, or floating. They often describe visual blurring, nausea, increased heart rate or blood pressure. Reactions to these symptoms may include fatigue, depression, decreased concentration or even panic. Symptoms may be short-term or last for years. Problems with balance are very disturbing at any age, but one of the most serious threats to older patients is the increased likelihood of falls.
As we age, bodily changes such as osteoporosis, arthritis, frailness and vision changes make falls more likely and recovery more difficult. Though anyone may fall, those who have balance disorders, use four or more drugs (prescription or over-the-counter) that affect brain function, have vision problems, or wear bifocals are more prone to falls. Persons wearing bifocals are more than twice as likely to fall as those wearing other types of glasses. One in three persons 65 or older will fall each year. Many of their injuries are serious or life-threatening and may include fractures, or brain or spinal cord injuries. According to the National Center for Injury Prevention and Control (CDC), falls are the most common cause of trauma-related hospital admissions and injury-related deaths for seniors. Falls can decrease mobility and independence leading to lifestyle changes.
 Causes of Balance Disorders
Balance is a coordinated effort between the eyes, inner ear, joints and muscles which send messages to the brain about body position. For instance, an organ in our inner ear, the labyrinth, is part of our vestibular balance system. The labyrinth interacts with other systems in the body, such as the eyes, bones and joints.
The eyes send visual signals to the brain about body position in relationship to surroundings. The brain processes these signals in comparison to those from the vestibular and skeletal system to maintain balance or orientation. When there are conflicting signals or problems with blood flow, dizziness or disequilibrium can occur.
Problems with circulation affecting the brain or inner ear, infections, certain medications, and aging may cause changes to the balance system. People with brain disorders or injuries to the visual or skeletal systems may experience balance disorders. A conflict of signals to the brain about the sensation of movement can cause motion sickness with symptoms of sweating, nausea and dizziness. Balance disorders may occur as a result of problems in four areas: 1) disturbance in the labyrinth; 2)problems in the brain or its connecting nerves; 3) systemic disorders in other parts of the body such as infections and; 4)blood circulation problems.
 Some more common Causes of Balance Disorders
Though there are many causes of balance disorders, some of the more common ones include:
• Benign Paroxysmal Positional Vertigo (BPPV): a brief, intense sensation of vertigo (dizziness) caused by change in position of the head. BPPV may occur when rolling over in bed or getting up in the morning. The reason is not known but it may be caused by ear infection, head injury, variations in blood pressure or aging.
• Labyrinthitis: infection or inflammation of the inner ear causes dizziness and loss of balance.
• Ménière’s disease: an inner ear fluid balance disorder that causes episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears) and sensation of fullness in the ear. The cause of Ménière’s disease is unknown.
• Vestibular neuronitis: infection of the vestibular nerve, generally viral.
• Perilymph fistula: inner ear fluid leakage to the middle ear that may occur after head injury or physical exertion.
Diagnosis and Treatment
Diagnosis is complicated because there are many different balance disorders and because health problems such as ear infections, blood pressure shifts, vision problems and medications may contribute to symptoms. Motto says that he relies heavily on the patient history and physical exam for diagnosis. Patients can assist the doctor with the diagnosis by bringing a written list of their symptoms and current medications. Primary care physicians may refer the patient to an otolaryngologist, a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck, with expertise in balance disorders.
After the history and physical examination, tests may be required to assess the cause of the balance problem. A hearing examination, blood tests, an electronystagmogram (ENG, a test of the vestibular system), or imaging studies of the head and brain may be done. A caloric test may be done as part of the ENG in which each ear is flushed with warm, then cool water. The amount of nystagmus that results is measured. Weakness or absence of nystagmus may indicate an inner ear disorder.
Posturography is another vestibular system test that requires the patient to stand on a platform that moves with a controlled visual environment. Body sway in response to platform movement is measured to determine inner ear disorder.
Treatment of balance disorders depends upon the underlying causes such as stroke, infection or other conditions. Health status, symptoms and test results determine treatment. Balance retraining exercises may be administered by specially trained professionals to help compensate for the disorder.
When Ménière’s disease is diagnosed, reduction of sodium in the diet, alcohol, caffeine or nicotine may be prescribed. Antibiotics such as streptomycin by injection and topical gentamycin are used to affect the hair cells of the balance system. Cases that do not respond to medical management may require surgery.
According to Motto, seniors may help prevent balance disorders by working to maintain healthy circulation. “It is important to control diabetes, cholesterol and triglycerides,” he explains. Any person experiencing dizziness should see a physician for evaluation. Prevention of falls can and will go a long way to ensure older adults maintain their health and quality of life.
 Charlotte Boatwright is a native Chattanoogan. She has a doctorate in health care administration, is a registered nurse and licensed professional counselor. Charlotte has been involved with health care for 35 + years and is the founding member and President of The Coalition Against Domestic & Community Violence of Greater Chattanooga, Inc./ Chattanooga Family Justice Alliance. She can be reached at cboatwright@comcast.net.

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