Do you or someone you know complain about dizziness, unsteadiness, or experiencing repeated falls?  That can be very frustrating and dangerous due to injuries resulting from a fall.  

There are many factors that can affect our balance.  The complex vestibular system includes our eyes (visual inputs), ears (vestibular inputs in the inner ear), and feet (proprioception inputs while walking). If any one of these three areas is off it can cause dizziness resulting in falls.  It's kind of like a three-legged stool, if one leg falls off, the stool tips over.  

The first course of action needs to be a visit to your primary physician/s for a detailed evaluation. The following questions are a valuable tool for the physician to receive a good history and determine the best next steps in forming an accurate diagnosis and treatment protocol.

1. How many times have you fallen in the last year?
2. Do you feel dizzy prior to a fall or more unaware of the imbalance?  
3. Do you have dizziness when lying in bed on a specific side but not on other sides? Or when moving your head one way or another?
4. Do you experience dizziness while standing up from a seated position? Or when going from a lying down position to sit up and then stand up?
5. Is there any numbness in your lower legs and feet? (Neuropathy or diabetic neuropathy)
6. Are there any medications taken that list dizziness as a side effect?
7. Have you experienced any head trauma recently?  Been in an accident or hit your head during a fall?

In addition to the questions from the physician above, at Secure Health, Inc. we highly recommend the physician use our Better Balance Analyzer platform to determine your Fall Risk Assessment (FRA).  The patient stands on the platform with eyes closed for 20 seconds - 3 times. The results are then compared to our large normative database, based on age and gender.  Your results determine if you are at low risk, moderate risk or high risk of falling.

Based on the results from the primary’s evaluation and considering the results from the Better Balance Analyzer, a referral to either an Ear, Nose, and Throat (ENT) or Audiologist (AuD) will likely be recommended.    

Once at your referred specialist, they may want to do a test called ENG or VNG (electronystagmography or Videonystagmography).  ENG has been around for 100 years while VNG, the modern gold standard method, has been around for 30+ years.  The VNG is very accurate and efficient.  Both are widely accepted as viable tests worldwide, but VNG is far more accurate, consistent and easier to administer. 

The ENG uses electrodes placed around your eyes and head while the VNG uses goggles with cameras to track eye movements while the patient follows stimulus, either a dot or light bars.  Using these tests, your health care provider can diagnose and identify vestibular problems or central nervous system (CNS) problems.  Another stimulus used with ENG/VNG is ear irrigation using either air or water  The air or water is blown into the ear canal purposely causing dizziness with a caloric irrigator.  The tests are done to see how long or if the patient can make the dizziness go away on their own, if not then it is likely central nervous system related.  

By far, the most common balance disorder is called Benign Paroxysmal Positional Vertigo (BPPV).  With BPPV you will feel dizzy only when you position your head in a certain way or position.  BPPV is generally caused when the crystals in your inner ear are out of position.  

Thankfully, BPPV is very treatable.  The most common treatment is the Canalith Repositioning maneuver that moves the crystals back to their intended position.  This is a painless movement, putting your head in various positions to allow the ear crystals to reposition in the correct manner. Vestibular rehab therapy is likely to be recommended to you to help with your recovery.

The vestibular system is very complex with far more potential diagnosis than just BPPV.  It is very important to go to the correct specialist for accurate diagnosis and treatments.

I hope this has helped in some way.  I know it's not anything absolute, but at least it may offer you some input on causes. This information is not intended as any sort of diagnostic or medical advice other than general information. You should seek your own personal care from a qualified medical professional.

May you all have a prosperous and healthy 2021.  Feel free to contact me at 260.804.4041 or email [email protected]

Dan Scherer

CEO, Secure Health, Inc.

260.804.4041 / [email protected]