Balance Disorders

Dizziness is a symptom, not a disease. It may be defined as a subjective sensation of unsteadiness or imbalance, or disorientation in relation to one’s surroundings. Dizziness can be caused by many different diseases and varies from a mild unsteadiness to a severe spinning sensation known as vertigo. It may or may not be accompanied by hearing loss or tinnitus.

The assessment of a patient complaining of dizziness, light headedness, vertigo, or unteadiness is often a daunting challenge. However, with a targeted history and systematic examination, the cause of the patients symptoms is almost always identified, a treatment program instituted or appropriate referral  made. Difficult cases often require a multi-disciplinary approach to investigation and management.

Vertigo is the false sense of motion.. This is classically rotatory, but can manifest as translational movement. It is the result of an imbalance of activity in either the peripheral or central vestibular pathways.

Vertigo is often used interchangeably with dizziness. Dizziness, however, is a non-specific term used to encompass any imbalance in the integration of multiple inputs contributing to the orientation of the head and body in space. The main components of this system comprise the visual, vestibular and proprioceptive systems, with their central interconnecting processing centres. When these inputs disagree dizziness occurs

Importantly there is no mechanism through which abnormalities of the vestibular system can cause a loss of consciousness.

As a matter of definition peripheral vestibular system lesions arise from either within the labyrinth or the VIIIth cranial nerve. Central lesions occur either at the brainstem or higher levels.

The assessment and management of any patient suspected of suffering from vertigo, begins with a careful history. The patients own description of their symptoms is often invaluable. The initial goal is to rule out any serious underlying pathology and then to outline the appropriate treatment.

The commonest causes of dizziness and vertigo that are managed by otologist and neurotologist include:

  • BPPV: Benign Paroxysmal Positional Vertigo
  • Migrainous Vertigo
  • Meniere’s Disease
  • Chronic Ear Disease
  • Acoustic Neuroma
  • Superior Canal Dehiscence Syndrome

See also St Vincent's Ear, Acoustic Neuroma, and Skullbase Courses for clinicians.