Imbalance often baffling

Balance is one of the least understood areas of medicine, says Dr. Don Worthington, which explains why the phones rang nonstop Saturday during the Deseret Morning News/Intermountain Healthcare Hotline.

Although the Hotline covered both balance and hearing, calls about vertigo, garden-variety dizziness, veering and that hard-to-describe sense of being a little off-kilter accounted for 80 percent of the calls to Worthington and Dr. Bryan Layton. Both audiologists are with the Intermountain Balance and Hearing Center in Salt Lake City.

One caller said she had been to 11 doctors and had gotten three different diagnoses but still continued to have problems with balance.

"Meniere's used to be a catch-all diagnosis," noted Layton during a brief lull in the calls. But many patients with occasional dizziness (typically when rolling over in bed, bending over or looking up) have an easily treatable condition known as benign paroxysmal positional vertigo (BPPV), he said. In the past dozen years, doctors have discovered that the condition is caused by inner ear crystals that break off and get lodged by mistake in one of the ear's semicircular canals.

Meniere's, on the other hand, is a confounding condition that can cause incapacitating episodes of extreme vertigo, nausea, intense pressure and ringing in one ear, and garbled sounds. Doctors don't know what causes Meniere's but do know it runs in families and can be triggered by a traumatic injury. Fluid builds up in the inner chamber of the inner ear, causing the membranes to push out against the tiny bones in the middle ear. Repeated Meniere's attacks can cause permanent damage to hearing.

Treatment includes diuretics and a low-sodium diet, as well as a fairly new treatment in which a very strong antibiotic is injected into the inner ear. The drug is toxic to the balance system and thus takes away function, so when attacks come they no longer cause vertigo.

The problem with Meniere's is that "if you give two patients the same medication, one will get relief and the other won't," Worthington says. "It's the darnedest thing."

Another frequent vertigo problem is caused by a viral attack of the hair cells in the inner ear. The condition, known as labyrinthitis, is sometimes temporary, sometimes permanent, but always attacks just one ear at a time.

Concussions can also lead to vertigo and dizziness; so can circulatory problems, since hair cells in both the hearing and balance systems of the inner ear are dependent on getting enough oxygen. And then there's "mal de debarquement" syndrome, occurring after a person steps off a long cruise or airline flight. While many people experience a residual feeling of up-and-down motion after such a trip, those with the syndrome are afflicted for months or even years.

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E-mail: jarvik@desnews.com