Do you also feel dizzy all the time? It could be a vestibular disorder!

Do you sometimes feel dizzy or spinning around in your seat? Some people also experience nausea and vomiting. If this happens frequently, don't dismiss it as normal. It could be due to a problem with your body's balance system, called the vestibular system. Today, we'll talk about vestibular disorders.

What are Vestibular Disorders?

Simply put, vestibular disorders are problems with the vestibular system, which controls your body's balance. This system includes parts of your inner ear and parts of your brain. These are what help you keep your body in balance.

Think about it, this system is what helps you keep your balance when you walk, turn your head, and jump. So, if there is a problem with the vestibular system in your inner ear, or with the parts of your central nervous system (CNS) that take this information to the brain and analyze it, you can have problems with your balance (vestibular dysfunction). Often, vestibular problems like these are the ones that cause dizziness and vertigo.

What are the main types of this condition?

Doctors classify these vestibular disorders based on where in your vestibular system the problem lies.

• Peripheral Vestibular Disorders (PVD): These are conditions that affect either your inner ear or the vestibular nerve, which carries balance signals to the brain. Think of it like a problem with the tiny sensory parts inside your ear.
• Central Vestibular Disorders (CVD): These are conditions that affect the parts of your brain that process balance signals from the peripheral vestibular system. This means that the brain cannot properly interpret information coming from the ears.

What are the most common vestibular disorders?

Some of these are commonly seen:

• Benign Paroxysmal Positional Vertigo (BPPV): This is the type of dizziness that most people experience when they suddenly turn their head.
• Ménière's disease: In this condition, along with dizziness, hearing loss and ringing in the ears may occur.
• Vestibular neuritis: This is when the vestibular nerve becomes inflamed.
• Labyrinthitis: This is an inflammation of the labyrinth of the inner ear, which can affect hearing.

Are there other types of vestibular disorders?

Yes, there are many more. These are a little complicated, but good to know:

• Acoustic neuroma
• Autoimmune inner ear disease
• Enlarged vestibular aqueducts (EVA)
• Mal de débarquement syndrome (MdDS) – This is a feeling like the earth is shaking even after you disembark from a ship.
• Otosclerosis
• Perilymphatic fistula (PLF)
• Persistent postural-perceptual dizziness (PPPD)
• Presbyvestibulopathy (PVP) – balance problems that occur with age.
• Secondary endolymphatic hydrops
• Superior semicircular canal dehiscence syndrome
• Vascular vertigo
• Vertebrobasilar insufficiency
• Vestibular ataxia
• Vestibular migraines – dizziness that accompanies migraines.
• Vestibular hypofunction
• Vestibular paroxysmia

Now you may be thinking, "Mom, what disease is this?" Don't worry, not everyone gets all of these. Only a specialist can diagnose these accurately.

What are the symptoms of a vestibular disorder?

There are two symptoms that are most commonly seen in this condition:

• Dizziness: This means feeling dizzy, lightheaded, or "woozy."
• Vertigo: This is when you feel like you're spinning, or like the room you're in is spinning around you. It's like going up and down on a swing.

In addition to these main symptoms, other symptoms may also appear depending on your specific condition. They include:

• Difficulty standing or sitting upright.
• Difficulty walking steadily (as if walking unsteadily).
• Hearing loss or ringing in the ears (this is called tinnitus ).
• Uncontrolled, irregular movement of the eyes (this is called nystagmus) .
• Blurred vision.
• Nausea and vomiting.
• Having difficulty concentrating on something.

Imagine, Nilanthi Akka from our village feels dizzy for about a minute every morning when she gets out of bed. She thought it was due to lack of sleep. But later, when she saw a doctor, she found out that it was a condition called BPPV (Benign Paroxysmal Positional Vertigo) . So if you have these symptoms, definitely see a doctor.

What are the causes of vestibular disorders?

There are a number of reasons why the vestibular system may malfunction.

• Aging: As you age, the structures in your inner ear that send balance signals to the brain can gradually weaken.
• Head injuries: A blow to the head can damage the inner ear or parts of the brain related to the vestibular system.
• Exposure to toxins: Ototoxicity is damage to the inner ear caused by certain medications you take. This is a major cause of vestibular dysfunction. The inner ear can also be damaged by chemicals in the environment (for example, lead).
• Inflammation: Inflammation can damage the organs and nerves in the inner ear that are involved in balance. Sometimes this inflammation can be caused by a viral or bacterial infection.
• Endolymph problems: The fluid in your inner ear called endolymph moves as your head moves. This movement activates the nerves that send information about your position to your brain. If there is a problem with this fluid, it can cause problems with the vestibular system, causing errors in signal transmission.
• Tumors: Some tumors (including tumors) in the brain or ear can affect the nerves that help you maintain balance.
• Autoimmune diseases: This is a bit rare, but in some autoimmune diseases, your own immune system can attack your inner ear.
• Neurological conditions: Diseases that affect your nerves and central nervous system (CNS) can cause your balance to be affected. Stroke is a common cause of central vestibular dysfunction. It can also be caused by diseases that damage the protective covering around the nerves (such as demyelinating diseases ).

What are the triggers that increase these symptoms?

People with some vestibular disorders experience symptoms, such as dizziness and vertigo, that come and go. In these cases, certain "triggers" can start or worsen symptoms. These triggers include:

• Changes in the environment: For example, suddenly going to a "busy" place full of people and seeing different things.
• Sudden head movements or changes in position: Like when lying down in bed.
• Some foods and drinks.
• Lack of sleep.
• Stress.

Your doctor can help you identify what things like these may be making your symptoms worse.

What are the possible side effects (complications) of this?

Vestibular dysfunction doesn't just affect your balance. If left untreated, it can lead to other problems as well.

• Falls: Balance problems can lead to dangerous falls. According to the World Health Organization (WHO), between 20% and 30% of older adults in the United States suffer head injuries, concussions, or hip fractures from falls. People over the age of 60 are at higher risk for these life-threatening falls. Imagine what it would be like if you suddenly felt dizzy and fell while walking down the hall.
• Long-term hearing loss: Some vestibular disorders are associated with long-term hearing loss. This can often be prevented if the condition is diagnosed and treated early.
• Mental health conditions: Vestibular dysfunction symptoms can make it difficult to perform everyday tasks, such as driving or walking. People may also avoid social interactions for fear of dizziness or vertigo. These effects can lead to mental health conditions such as anxiety and depression .

Therefore, it is very important to seek medical advice and treatment promptly without increasing the risk of further health problems.

How are vestibular disorders diagnosed?

Your doctor will diagnose the condition by performing a physical exam and a neurological exam. They will also ask about your symptoms. Understanding your symptoms is key to determining whether the problem is in the inner ear or the central nervous system (CNS).

What kind of specialist should I see?

There are several doctors who can diagnose and treat vestibular disorders:

• Otolaryngologists (ENTs).
• Vestibular audiologists.
• Neurologists.
• Physical therapists.

What kind of tests are done to diagnose this?

It is possible to do tests like this:

• Vestibular tests: These can check how the vestibular organs in your inner ear are working. Most often, these tests look at how your eyes and inner ear work together to help you maintain balance.
• Hearing tests: These check for symptoms such as hearing loss or ringing in the ears (tinnitus), which may be related to a vestibular disorder.
• Imaging tests: You may need to have an MRI (magnetic resonance imaging) or CT scan (computed tomography scan) to see if there are any structural problems in your inner ear or brain.
• Blood tests: These can check for infections that could be causing inner ear problems.

How are vestibular disorders treated?

The treatment you receive will depend on your specific condition. Vestibular disorders can be treated by:

• Lifestyle changes: Simple lifestyle changes can help manage some vestibular disorders. For example, if fluid buildup in your ears is a problem, cutting back on salty foods (which can cause water retention) may help. It's also important to learn to identify and manage triggers that can trigger vertigo.
• Medications: You may need medications to treat the cause of your condition or to control your symptoms. For example, you may need antibiotics to treat bacterial infections, or diuretics to reduce fluid buildup in your ears. You may need anti-nausea medications or antihistamines to control symptoms such as motion sickness.
• Canalith repositioning procedure: If you have BPPV (Benign Paroxysmal Positional Vertigo) , this treatment, in conjunction with a physical therapist, can help reposition small pieces of canaliths in your inner ear that have become dislodged.
• Vestibular rehabilitation: Vestibular rehabilitation therapy includes exercise sessions that help control dizziness and vertigo.
• Surgery: Inner ear surgery is often performed as a last resort to treat vestibular disorders. However, it may be necessary to control severe vertigo symptoms if other treatments have not helped.

What can you expect when living with this condition?

Your condition depends on the specific vestibular disorder you have. In some cases, vestibular problems go away on their own. For example, vestibular problems related to infections usually get better once the virus or bacteria is gone. However, it is important to get treatment as soon as possible to prevent long-term damage to the inner ear.

Other vestibular disorders require lifelong management. Symptoms can come and go unexpectedly, or in response to triggers that you recognize. If this is the case for you, you will need to work with your doctor (or care team) to manage your condition.

Can vestibular disorders be prevented?

It depends on the cause of the vestibular disorder, but vestibular disorders are generally difficult to prevent.

But there are things you can do to take care of yourself. For example, you can get treatment early to prevent long-term damage from causes like infections. If you live with a long-lasting condition, you can take steps to reduce your risk of falls.

How do I take care of myself?

Often, a combination of lifestyle changes, medications, and vestibular rehabilitation are used to treat or manage vestibular disorders. But most people can find a treatment plan that works for them. In the meantime, you can take care of yourself by:

• Always keep your medicine with you.
• If you feel like symptoms are starting to appear, take some time off and rest.
• Avoid risky activities if you are not sure they are safe.
• If you smoke, avoid it (or quit). Smoking can worsen symptoms.
• Reduce caffeine and alcohol. These are common triggers that increase symptoms.

What questions should I ask my doctor?

You can ask questions like these:

• Why did I develop this vestibular disorder?
• What tests should be done to diagnose my condition?
• What kind of treatment do I need?
• How do I manage triggers?
• What changes can I make to reduce the risk of falls?

Finally, the most important thing (Take-Home Message)

Many of us don't realize how important balance is to our daily lives until we have a problem. It's when we suddenly feel like the room is spinning that we realize its value. Sometimes this feeling goes away after a while. But if you have a vestibular disorder, it's important to see a doctor and get treatment before this vertigo becomes something dangerous like a fall. Your doctor can help you find the right combination of treatments to correct your balance problem, manage your symptoms, and help you find the right combination of treatments for you. Don't worry, most of these conditions can be managed well.

` Vestibular disorders, dizziness, vertigo, balance, inner ear, Meniere's disease, BPPV