Some little known Facts about dizziness and balance disorders

By Dr Asha Nayak

1. Dizziness is one of the most common diagnoses requiring hospital stay of around 4 days.

2. More than 70% are treated by primary physicians.

3. Less than 10% of dizzy patients are ever evaluated by a specialist (Otology, Audiology or Neurology).

4. 50% of patients complaining of dizziness in a primary care setting do not get a diagnosis.

5. Nearly 50% of elderly patients admitted for hip fractures become chronic patients.

6. MRI exams have a very low yield for patients undergoing examinations for dizziness.

7. All that is dizzy is not vestibular. Visual and somatosensory input as well as efficient brainstem integration also contribute to normal balance function.

8. Approximately 1000 medications enlist dizziness, vertigo, or light-headedness as a possible side-effect.

9. Vestibular disorders are responsible in over 50% of patients complaining of dizziness.

10. Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of episodic vertigo.

11. BPPV is treated successfully in over one or two office sessions over 90% of the time.

12. In patients with chronic balance problems, only vestibular rehabilitation has shown to improve balance function and performance when compared to medical therapy or general exercises.

13. Therapy directed towards a specific diagnosis resulted in resolution of symptoms in 85% of the cases, while general vestibular rehabilitation exercises resulted in complete resolution in 64%.

Treatment for Dizziness

The leading cause of dizziness is a condition known as Benign Paroxysmal Positional Vertigo, or BPPV. In the vestibular portion of the inner ear are salt-like crystals called "otoliths". With BPPV, these crystals break loose and gather with debris which can float into or attach itself to the semicircular canals.

The symptoms of BPPV can include dizziness or vertigo, lightheadedness, imbalance and nausea. Typically, the symptoms are brought about due to a change in head position. Common complaints are dizziness when rolling over or getting out of bed, looking up or bending down. The symptoms of BPPV may be present for a few weeks, then stop, and then come back again.

The most common cause of BPPV in people under age 50 is head injury or whiplash. It is also common to experience BPPV following a sinus infection or severe head congestion. In older persons. the condition may contribute to degeneration of the vestibular system of the inner ear. In most cases, BPPV is said to be idiopathic, or for no known reason.

The most successful treatment for BPPV is a maneuver of the head to float the cyrstals and debris back into place. This is known as canalith repositioning. After a proper diagnosis of BPPV has been made, this maneuver is typically 90-95% effective in elimination the devastating symptoms of this disorder.

Repositioning maneuver provides immediate relief, but this can only be performed by an expert as it entails movement of the head in different positions in order to effectively treat the patients suffering from positional vertigo instantly. Other kinds of vestibular problems may respond well to adaptation and habituation exercises provided by a trained physiotherapist.