Vertigo

WHAT IS VERTIGO?

Vertigo is a sensation of feeling off balance. If you have these dizzy spells, you might feel like you are spinning or that the world around you is spinning.

Ever wonder what helps keep your balance when you get out of your bed or your chair and walk on the floor? What is the mechanism in your body that prevents you from falling after each step, or helps you strike that balanced yoga pose?

A connection from your inner ear to your brain which is known as the vestibular system helps in this along with assistance from the visual system and sensors in your skin, muscles and joints.

VESTIBULAR DISORDERS

Vestibular disorders occur when a disease or damage occurs to the balance system. The common signs of vestibular disorders are vertigo, dizziness, imbalance,nausea and vomiting.

Individuals suffering from vestibular disorders also find that they have difficulty in concentrating, recalling things, poor memory, difficulty in reading printed media and impaired mental stamina. More than 35% of geriatrics and adults experience some symptoms of vestibular disorders during their lifetime

Treatment for various speech and language disorders

Some Vestibular disorders with their symptoms and causes are :

Benign paroxysmal positional vertigo or BPPV, a type of positional vertigo, which is indicated by sudden swaying or spinning.

Vestibular neuritis which affects the balance nerve occurs in a person who has had a viral infection such as measles and chickenpox to name a few.

Labrynthitis is an inner ear infection which happens due to the inflammation of one of the structures within the inner ear known as the labyrinth. This infection is accompanied by pus or fluid from the ear, hearing loss and balance issues.

Perilymphatic fistula is caused by a defect between the inner ear and middle ear which causes hearing loss or dizziness. Surgical intervention may cure the defect.

Acoustic neuroma is a non cancerous tumor which grows to press against the hearing nerve and the balance nerve affecting those functions.

Some ototoxic drugs may cause reversible vestibular issues.

Enlarged vestibular aqueducts are mostly genetic in nature where a structure, known as the vestibular aqueduct, is larger than its normal size and may cause hearing loss.

Vestibular migraine is a common condition where the transmission of the signals between the brain and the balance system are affected. This causes severe headache, hypersensitivity to light or sound, dizziness, hearing loss and ringing in the ears.

The severity and type of disorders can vary and so can the symptoms. This makes it difficult to describe. Many disorders go unnoticed because the client does not know how to sort out their symptoms or because others dont take them seriously because of how varying their symptoms are.

Many people suffering from vestibular disorders find it difficult to focus on work and are considered lazy or attention seeking. Proper triaging is the key and this is taken care of by our experienced audiologists.

BALANCE SYSTEM

HOW DOES IT WORK?

The vestibular system in each inner ear consists of 3 semicircular canalsl and two pockets called the otolith organs.

WHAT DOES THE SEMICIRCULAR CANAL AND OTOLITH ORGANS DO?

The 3 semicircular canals consist of fluid which moves during head movements causing it to stimulate the tiny hairs within the structure which sends messages to the brain via the balance (vestibular) nerve. Each of these canals have a different orientation which helps recognize the kind of movement such as nodding or rotating.

The 2 otolith organs known as the utricle and saccule send messages to the brain about the body’s movement with the small crystals present in them which displace during movements to stimulate the tiny hairs which transfer the information to the brain via the balance nerve.

For e.g If you are walking in a straight line or backwards, or if you are climbing up or down the stairs/slope.

It also gives information about the position of your head in relation to gravity.

For e.g. if you are lying down or leaning

To learn more about vestibular disorders and how the test works and the ways to fix it.

BALANCE SYSTEM ASSESSMENTS DONE AT OUR CLINIC

Otoscopy

The audiologist uses an instrument to look into your ear to determine the presence of wax or any abnormalities that may hinder further healing testing.

Pure tone audiometry (PTA)

You will be asked to wear headphones and sit in a specially designed booth. You will be instructed to raise your hand or press a button every time you hear beeps.This test is done to find out the softest sound that you can hear. The results will be noted by the audiologist on an audiogram and will be discussed with you after all the required tests are done.

Bone conduction audiometry

An instrument will be placed behind your ear which sends sound through the bone to your inner ear and the same instruction for pure tone audiometry is given. This test helps to determine your type of hearing loss.

Tympanometry / Impedance Test

A tip is put in the ear, a slight pressure is introduced to the ear which helps determine the presence of fluid buildup, wax,negative pressures or perforations.This test in addition to other assessments help in ascertaining the location of your hearing problem or middle ear infections.

Special tests:

There are a number of test used in specific circumstances where routine Pure Tone Audiometry and/or Speech Audiometry is not sufficient to reach a diagnosis or guide audiological,vestibular management decision making.They are additionally helpful in diagniosing the cause of hearing loss or balance disorder in association with other tests:

Stenger = a test with binaural sound presentation, which utilises a phenomenon of binaural interaction to indicate from which ear a sound is being perceived. This test is useful in cases of suspected unilateral non-organic hearing loss.

Langenbeck = This is a suprathreshold test where noise and pure tones are presented to the same ear, and the intensity of the pure tone that can be discriminated from the noise is measured in order to assess the masking pattern needed to mask a sound.

Weber = A test of sound lateralisation when test signals are presented by bone conduction. This test is useful in identifying asymmetrical hearing loss as the sound will tend to lateralise to the better hearing ear.

Alternate Binaural Loudness Balance (ABLB) = a test with sounds (typically pure tones of the same frequency) alternated between ears. Those in one ear are adjusted in level to match the other for loudness – at which point sounds are said to be balanced. Amongst other applications, this test is useful as part of a test battery for diagnosing retrocochlear disorders. In particular, it is used as a preliminary test for Auditory Brainstem Response interaural latency and intensity comparisons.

Short Increment Sensitivity Index (SISI) = This tests the ability of the listener to detect small increases in loudess. This helps identify recruitment and, amongst other applications, this test is useful as part of a test battery for differentiating cochlear from retrocochlear disorders.

Electrocochleography(EcochG)

Electrocochleography, commonly referred to as ECochG, is a painless test of hearing function that is usually done to determine if there is too much fluid in the inner ear. Over accumulation of fluid in the inner ear may cause dizziness/vertigo, fluctuating hearing loss, a feeling of fullness and/or pressure in the ears, and tinnitus (ringing/buzzing/rushing sound in the ears). Evaluates the inner ear’s response to sound and helps determine the function of the cochlea.

Videonystagmography

Videonystagmography (VNG) is a test that measures a type of involuntary eye movement called nystagmus. These movements can be slow or fast, steady or jerky. Nystagmus causes your eyes to move from side to side or up and down, or both. Videonystagmography is a technology for testing inner ear and central motor functions, a process known as vestibular assessment. It involves the use of infrared goggles to trace eye movements during visual stimulation and positional changes.

VESTIBULAR REHABILITATION

Vestibular Rehabilitation Therapy or VRT is a successful treatment which has a recovery rate of 70-80 %.Low impact exercises such as yoga which aids with restoration of balance will be suggested by our specialist with the opinion of our occupational therapist if needed.
Balance Training exercises key in resolving issues with balancing especially in cases like labrynthitis. The goal is to improve steadiness so that the person can do normal day to day activities. Gaze stabilization and positional exercises are some of many specific vestibular exercises that are done based on the symptoms reported to our specialists.