Balance disorder

Symptoms that indicate a balance disorder, such as dizziness and vertigo, are among the most common causes of visiting clinics of various specialties.

Vertigo always hides a feeling of rotation and is usually due to problems of the labyrinth. Dizziness is an unpleasant experience that causes fear and insecurity for all people who have experienced it.

For balance, several individual systems need to function properly. The central nervous system as a coordinator, the vestibular (labyrinth) with the inner ear as a sensory organ, and also the vision with an executive controlling role.

So self-evident is the balance, but so complex in its completion. We understand its value when we lose it.

Loss of balance can be caused by a number of things:

1. Otological diseases affecting the function of the labyrinth, with the most common condition being positional vertigo. This is a benign disease, which often requires only one manipulation to relieve the patient of days or sometimes weeks of discomfort.
   
2. Neurological conditions, from acute vascular attacks to neurodegenerative diseases, may be behind a dizzy spell. Our role in these cases is to quickly make a correct diagnosis of a disease that may be potentially life-threatening for the sufferer.
   
3. Problems of the musculoskeletal system, most notably those of the cervical spine, impair balance and make it laborious. These patients feel constantly unstable, resulting in fatigue and frustration even for their daily activities. Individual rehabilitation programmes are of great help to this category of patients.

Due to the complexity of the balance disorder, its successful approach requires methodicalness, knowledge, patience, a good patient-patient relationship and modern diagnostic equipment.

Today, we have a range of tests available to determine the root cause and recommend the optimal therapeutic intervention.

Regarding the labyrinth, we examine all five end sensory organs (3 semicircular tubes and 2 vesicles).

With the head impulse test we can calculate the damage of each semicircular tube individually. The test is used both in the acute phase and to monitor the recovery of the condition.

By determining the visual vertical, we can see if the patient correctly feels the vertical in the environment, so that he or she can harmonize with gravity. When the whole body is tilted (torso - head - eyes), we understand how much more difficult it is to balance and consequently how much more difficult it is to strain muscles and joints.

In a next step, and especially in patients with concomitant neurological diseases, we check oculomotor activity, looking for lesions more centrally in the brain (brainstem) and cerebellum that may be related to the symptoms. For proper balance, a stable visual field is needed.

Finally, with special equipment, we are able to evaluate many parameters of posture. We listen to all patients who have difficulties with balance and in previous examinations nothing special has been detected. We try to find dysfunctions and treat them in a completely different way than we have done so far. Medication is not as important as an individualized program of exercises and balance retraining. Proprioception must be strengthened and the patient must regain the lost balance automatisms and enhance his/her self-confidence. In this way, we also reduce the risk of falls in older age, with all the attendant benefits.

The tools we have today are many. Above we have briefly mentioned only a few of them. Depending on the individual case, we proceed to those test examinations that are needed to shed light on every little detail that is necessary for the right balance. Our aim is to improve the quality of life of patients who have been suffering for a long time, and to provide immediate therapeutic intervention in acute episodes.

The "St.Lucas" Clinic operates the Balance Disorders Investigation Clinic, which is addressed to all patients suffering from dizziness, vertigo, instability.

Its purpose is to examine separately all the subsystems that contribute to the maintenance of proper - functional balance and to identify any deficiencies. The tests are numerous and are performed depending on the clinical picture and the patient's history. Particular emphasis is also placed on calculating the risk of falling in the elderly and chronically ill. The therapeutic approach ranges from simple counselling and medication to liberating manipulations and individualised programmes to restore labyrinthine function and enhance proprioception. Treatment starts from the diagnosis. There are no magic solutions to such a difficult problem, but we can certainly develop strategies for effective treatment.

Text:
Antonios An. Antonos AntoniosVassiliadis, ENT Surgeon

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