Balance and Dizziness

Problems with balance and dizziness can have a broad spectrum of causes. Typically, these disorders are diagnosed as being either central (the brain) or peripheral (the inner ear) in origin. By using state-of-the-art testing to record the body’s reactions to different types of stimuli, we are able to identify the part(s) of the balance system responsible for the symptoms. Audiology by Accent utilizes electronystagmography and videonystagmography (ENG/VNG), vestibular evoked myogenic potentials (VEMP), and electrocochleography (ECochG) to provide our otolaryngologists with the data they need to diagnose and treat the cause of dizziness and/or imbalance experienced by each individual patient.

General Vertigo

The cause of vertigo is usually defined by the location of its cause. ENG/VNG, ECochG, and VEMP testing are used to determine the source of a person’s balance problems. Below are explanations of the two general sites of origin.

Central

Vertigo of central origin refers to dizziness and imbalance caused by the brain’s inability to correctly process input from the three components of the balance system: (1) proprioception, or the body’s ability to feel the ground below; (2) vision, which gives the brain information on the body’s orientation by seeing the world around it; (3) vestibular, which uses sensitive direction-specific organs to track the body’s movements. Any dysfunction in the brain’s ability to assess the messages coming from these components can create a false sense of imbalance and/or dizziness. Central vertigo can be caused by aging, tumors, demylenization (the thinning of the fatty insulation around the neurons), and other neurological disorders.

Peripheral

Vertigo of peripheral origin refers to dizziness and/or imbalance which is caused by a dysfunction of the otolith organs of the inner ear, which comprise the peripheral vestibular system. In simple terms, the human balance system can be drawn by imagining that the system is a see-saw, with the inner ear organs on the ends and the brain in the center gauging how each side moves. When something changes on one of the ends that shouldn’t be changing, this confuses the brain and can create a false sense of imbalance and/or dizziness. Keeping this example in mind, a common cause of peripheral vertigo is when the organs in one ear function better than the other, tipping the see-saw to one direction. There are some cases where the function of both sides is reduced or even absent, limiting the overall information the brain has to determine the body’s orientation in space and thereby creating a sensation of unevenness.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is caused when small crystals called otoconia are displaced from their normal location in the semicircular canals of the vestibular organ. This displacement creates abnormal stimulation of the vestibular system, resulting in a sense of dizziness. This is the most common form of vertigo. Dizziness is typically experienced with this condition when a person alters the position of their head and/or body, triggering an unpleasant spinning sensation. Evaluations for BPPV, called the Dix-Hallpike maneuver, are often performed by a physician or a physician’s assistant, and are also performed during routine ENG/VNG testing. BPPV is usually easily treated with specific body movements called Canalith Repositioning Maneuvers (CRMs).

Ménèire’s Disease

Ménèire’s disease can occur in either the cochlea (hearing organ) or one of the vestibular organs. Symptoms may include temporary or permanent low-frequency hearing loss, spinning vertigo, a sensation of fullness of the ear, and “roaring” type tinnitus (ringing of the ear) which may be persistent or intermittent. These symptoms are a result of elevated pressure of the fluid inside of these organs – called hydrops – which suppresses their ability to function properly and creates hearing and/or balance problems. The ECochG test is used to detect hydrops in the cochlea by measuring very small brain waves produced by the nerves in the cochlea. VEMP testing can also be used to detect hydrops of the saccule – the organ responsible for detecting upward and downward motion – by comparing the results from the problematic ear to the opposite ear.