Common Diagnoses

Labyrinthitis

Labyrinthitis is defined as an acute inflammation of the labyrinth (inner ear hearing and balance organs). When suffering from labyrinthitis, an individual will experience a combination of severe vertigo, dizziness and associated hearing loss. This diagnosis differs from Vestibluar Neuritis where only the balance function is impaired. Labyrinthitis is usually due to a viral etiology and often will follow a flu-like illness. Rarely, it is caused by an acute bacterial infection, or by a more chronic disease process, such as cholesteatoma. Labyrinthitis is usually treated acutely with supportive care for the vertigo, and steroids for the inner ear inflammation. Vestibular testing may be useful to determine the amount of acute damage caused by the labyrinthitis to the inner ear, and the resulting level of balance dysfunction. Many patients may benefit from Vestibular Rehabilitation (balance) Therapy for persistent balance problems. Some patients may also need amplification for hearing loss. Patients with labyrinthitis symptoms should be seen by an ear specialist to maximize their recovery from the event.

Vestibular Neuritis

Vestibular neuritis is defined as an acute inflammation of the vestibular (balance) nerve. In an attack of vestibular neuritis, the patient will experience severe vertigo, nausea, and vomiting that may last for several days, followed by persistent balance dysfunction that lasts for weeks to months. This diagnosis differs from labyrinthitis, where both the hearing and balance function are affected. The cause of vestibular neuritis is thought to be viral and occurrence is often preceded by cold or flu-like symptoms. Vestibular neuritis is usually treated acutely with supportive care for the vertigo, and steroids for the inner ear inflammation. Vestibular testing may be useful to determine the amount of acute damage caused by the vestibular neuritis to the vestibular nerve, and the resulting level of balance dysfunction. Many patients may benefit from Vestibular Rehabilitation (balance) Therapy for persistent balance problems. Patients with vestibular neuritis symptoms should be seen by an ear specialist to maximize their recovery from the event.

Stroke

A stroke involving the brainstem or cerebellum may cause acute vertigo or dizziness symptoms. Usually there are other presenting stroke symptoms such as difficulty speaking and paralysis that occur in addition to vertigo. However, occasionally the patient presents with severe vertigo as the only symptom. Chronic balance dysfunction commonly persists after the initial recovery period. Vestibular testing can determine the degree of persistent balance dysfunction following a stroke. Most individuals who have suffered a stroke will benefit from Vestibular Rehabilitation (balance) Therapy to improve their overall balance function and safety in movement.

Vestibular Schwannoma

An Vestibular Schwannoma (also known as an Acoustic Neuroma) is a non-cancerous tumor that grows on the cochleovestibular (hearing and balance) nerve that connects the inner ear to the brain. The tumor actually arises from support cells, known as schwann cells, that surround the nerve and typically starts on the vestibular (balance) nerve, but will often invade the cochlear (hearing) nerve as it grows. Symptoms of vestibular schwannomas include hearing loss and tinnitus on the affected side, and dizziness or balance problems. As these symptoms are also associated with a variety of other diagnoses affecting the ear and brain, just having the above symptoms does not mean one has an acoustic neuroma. An MRI scan with contrast can confirm or disprove the presence of an acoustic neuroma. Vestibular testing is often useful in determining the amount of damage to the balance nerve by the tumor. Recommended treatment is dependent on several factors including the size of the tumor, the patient's age, hearing, and general health. Treatment options include surgery, stereotactic radiotherapy (cyberknife, gammaknife) and observation. Patients with acoustic neuromas should be evaluated and managed by a skull base surgery team including a neurotologist, neurosurgeon, neuroradiologist and radiation oncologist. (link to skull base surgery center when available).

Patients who have undergone treatment for vestibular schwannomas often have long-term balance problems and can benefit from Vestibular Rehabilitation (balance) Therapy to help them recover function and improve safety in movement.

Motor or Visual Disturbances

The body's visual and motor systems are essential to maintain proper balance. An ongoing problem with either system can independently cause dizziness or balance problems, or can intensify an underlying balance problem. Visual disturbances include such problems as presbyopia, glaucoma, cataracts, macular degeneration, as well as motor problems of the eye such as strabismus. Motor problems include any disease process that affects motion and stability of the limbs and include such disorders such as Parkinson's disease and Multiple Sclerosis. Specialized balance tests, particularly Computerized Dynamic Posturography, can help determine how much motor and vestibular disturbances may be contributing to an individual's balance problems. Patients with motor or visual disturbances that affect their balance function can benefit from Vestibular Rehabilitation Therapy to improve their overall balance function and safety in movement.

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