Insights into inner ear balance problems

Given that Balance Awareness Week is coming up soon (16 – 22 September 2018), Mr Sameer Khemani, consultant ENT surgeon shares some insights into two of the most common balance problems that he sees in his balance clinic. He focuses on inner ear balance problems but don’t forget that certain types of dizziness and balance problems can also be brought on by changes in the heart or brain.

Benign Paroxysmal Positional Vertigo (BPPV)

This common condition can affect people of all ages but becomes more common as people get older. Individuals complain of approximately 30-60 seconds of intense vertigo brought on by head movements. “Vertigo” is the sensation of movement and in this case most people describe a spinning sensation. Classically it is brought on by turning in bed to one side, but can occur when bending down to do up shoelaces or when reaching up to get something out of a kitchen cupboard. People can often feel a little “spaced out” after it happens. It is caused by tiny little “crystals” inside the inner ear escaping from their normal enclosure into another part of the balance system. This can occur without any good reason, after trauma or after any period of immobility. It can also occur in conjunction with other balance disorders. The good news is that repositioning manoeuvres performed in the outpatient clinic can help most people by putting the “crystals” back into position. The most famous of these manoeuvres is known as the “Epley manoeuvre”. Treatment for this condition is extremely effective.

Vestibular Migraine

Most people think of migraine as just a bad headache. Migraine is actually a complex neurochemical change in part of the brain. The same process can affect the balance system and can make people feel very imbalanced and sometimes precipitate a feeling of spinning. Unfortunately, many people with this problem come to see me after having had a number of appointments with doctors with no diagnosis or have been told that they have had an inner ear infection (labyrinthitis). Often there are triggers for the symptoms of dizziness such as certain foods, hormonal changes and stress. Visual triggers can also precipitate the symptoms. These include being in bright, stark environments like supermarkets or when being dazzled by lights of oncoming traffic when driving. Spending a lot of time staring at computer screens or scrolling on tablets or mobile phones can also be problematic for some people. We normally treat cases like this with migraine prevention medications along with a form of balance rehabilitation and these treatments are usually quite effective.

If you or a family member are suffering with dizziness and are looking for advice or treatment, you may wish to book an appointment with Mr Sameer Khemani, consultant ENT surgeon.