Common Diagnoses

Dizziness

Dizziness is a nonspecific term used to describe a variety of sensations a person may feel including lightheadedness, off-balance, floating, fuzzy thinking, and faintness. Dizziness that gives the person a sensation of spinning is known as vertigo. Dizziness can be caused by a number of different causes including inner ear disorders, central brain disorders, vascular problems, metabolic problems, and infections. Patients experiencing symptoms of ongoing, or recurrent, dizziness should be evaluated by their physician. Vestibular testing may be useful in determining the cause of dizziness.

Vertigo

Vertigo is a term used to describe a whirling or spinning sensation either of the individual or the surrounding environment. Vertigo is a description of a symptom and not a diagnosis. Vertigo can be caused by dysfunction of the inner ear's balance organ or may be caused by a problem in the brain's processing of the balance signals. Vestibular testing can be used to help determine the cause of vertigo.

Imbalance/Balance Problem

A balance disorder is any disturbance that causes an individual feel dizzy, unsteady, light headed, sensation of spinning, vertiginous, or, in general, leads to difficulty maintaining his or her balance. The labyrinth (inner ear balance organ) is an important part of the balance system. The labyrinth must interact with other body systems including visual (eyes) and proprioceptive (muscles, tendons and joints) to maintain balance. In addition, the brain has to appropriately integrate and interpret all of the signals and subsequently send appropriate instructions back to the body regarding proper balance alignment. Functional problems of the labyrinth, visual or proprioceptive inputs, or the brain's interpretation of the inputs, can negatively affect one's balance.

Vestibular test modalities and radiologic studies help us to evaluate the potential cause of a specific balance disorder. The Balance Center at Westchester Medical Center uses the most technologically advanced test modalities to evaluate causes of balance disorders. Test equipment including Videonystagmography (VNG/ENG), Rotary Chair Testing, and Computerized Dynamic Posturography may be used to evaluate causes of balance disorders and effect appropriate intervention.

Meniere's Disease

Ménière's disease is a disorder of the inner ear resulting from increased and fluctuating pressure of endolymph fluid. Ménière's disease is characterized by symptoms of fluctuating low frequency hearing loss, recurrent vertigo events lasting 15 minutes-2 hours in duration, fullness or pressure in the ear, and tinnitus. The vertigo events, known as Ménière's attacks, may occur as infrequently as once every few years, to as often as several times a week. With repeat occurrences, many patients will experience a gradual decline in hearing in the affected ear. Patients with frequent vertigo events may have chronic dizziness or balance problems, even when not experience an acute Ménière's attack. The potential factors contributing to Ménière's disease include trauma, infection, allergies, autoimmune disorders, stress, diet and metabolic imbalance, but for many patients there is no identifiable contributing cause. Ménière's disease usually presents in one ear, but over 20 years, approximately 20% of patients will exhibit symptoms in both ears.

Ménière's disease is a clinical diagnosis, based on the presentation of the classic symptoms listed above. However, vestibular test modalities including VNG, Rotary Chair and Posturography are useful in confirming the diagnosis and in establishing a care plan for an individual patient. Vestibular testing may also be employed to assess the inner ear function and balance compensation after certain treatments are administered.

While there is no cure for Ménière's disease, there are many treatment options available that can effectively control symptoms of the disease. First level interventions include medical therapy with diuretics, allergy management, and dietary control. Second level treatment options including endolymphatic sac/shunt surgery, inner ear gentamicin perfusion, inner ear steroid perfusion, and the Meniett Device. Third level interventions, reserved for patients who have failed first and second level treatments, include surgical interventions of labyrinthectomy and vestibular nerve section. Because Ménière's disease presents differently in each individual, the best treatment plan will also vary from patient to patient. Patients with Ménière's disease should be managed by a neurotologist, specializing in disorders of the inner ear, and capable of providing them with a range of treatment options to control the disease.

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