From Deseret News archives:
Most common balance disorder is easy to correct
The condition, known as benign paroxysmal positional vertigo, or BPPV, causes extreme dizziness and results from a displacement of tiny calcium carbonate crystals in the inner ear, explains audiologist Dr. Don Worthington, director of the Intermountain Hearing and Balance Center. Worthington and associate director Dr. Bryan Layton, who is also an audiologist, will man the Deseret News-Intermountain Healthcare Health Hotline on Saturday. The toll-free number of the hotline, which runs from 10 a.m. to noon, is 1-800-925-8177.
Doctors have known about the crystals for centuries, but only in the past dozen years has anyone realized that some of the crystals break off and can wander into one of the ear's semicircular canals, causing a mix-up in the brain's ability to understand where we are as we move through the world.
The condition usually presents itself in the most innocuous of circumstances. Common triggers include rolling over in bed, bending over, getting into and out of bed, and looking up or down. The result is intense bursts of vertigo, along with nausea. Fortunately, as the name suggests, the vertigo is episodic (paroxysmal) rather than persistent.
With aging, the gelatinous glue that holds the crystals in place can weaken, causing the crystals to dislodge. For some unknown reason, twice as many older women as men develop the condition. In men, Worthington says, "it's more related to the stupid things we do: motorcycles, falling off scaffolding," leading to head injuries that break the crystals loose.
Treatment for BPPV is remarkably simple: repositioning the head, 45 degrees at a time, until the crystals are back where they belong.
Inner ear disorders causing vertigo can also be caused by short-term viral inflammation and chronic Meniere's disease. In the latter (for some reason that doctors don't yet understand), the body produces more fluid in the inner than the outer chamber of the inner ear, causing the membranes to push out against the tiny bones in the middle ear — resulting in hearing loss, ringing in the ear, and vertigo.
But not all balance disorders include vertigo; many people simply feel a little off-kilter — but sometimes enough off-kilter to cause them to fall. An estimated one-third to one-half of persons age 65 and older fall each year, Worthington notes.
Deteriorating hair cells in the balance portion of the inner ear can lead to balance problems (much as damaged hair cells in the hearing portion of the inner ear can cause hearing loss). Multiple sclerosis, Parkinson's, strokes and poor circulation can also cause balance problems, as can long periods of bed rest and inactivity. And some people simply have balance systems that over-react. "Balance rehabilitation can help these people as well," Worthington says, "but it's more difficult to treat."
National studies, he says, have found that 75 to 80 percent of persons with balance problems are good candidates for balance therapy, and 80 to 90 percent of those people "show a significant reduction in balance disability and symptoms" following proper treatment.
E-mail: jarvik@desnews.com
