Specialized Program Addresses Vertigo, Dizziness

While chronic dizziness may be a condition that people just had to live with in the past, a unique collaborative approach to diagnosis and treatment is now available to provide help.

The Upper Valley Medical Center (UVMC) Vestibular and Balance Program has all the services needed to help patients with dizziness and balance problems get back on their feet.  The program combines the expertise of the medical arena through ear, nose and throat specialists with the diagnostic efforts of an audiologist and treatment available through a physical therapist.

UVMC is the only hospital outside Miami Valley Hospital in Dayton to offer such a comprehensive balance program.

“You can go to one place here to find out what is wrong, and get treatment,” said audiologist Jane Rudy.

Dizziness is one of the most common reasons people go to see their family doctor, she said.  Physicians often refer patients to the program when they face balance issues associated with dizziness/vertigo, musculoskeletal disorders and neurological conditions.

“The knowledge of vestibular problems has grown enormously in the past five to 10 years,” said Sarah Conover, UVMC physical therapist who specializes in vestibular rehabilitation.  That specialization is hard to find, Rudy noted.

Conover said balance problems most often are tied to a problem in the inner ear, also called the vestibular system.  They also may be associated with a central nervous system or vascular problem.  And, they can be caused by reaction to medications, especially high-power antibiotics.

“No matter what the source, a disorder will disrupt the status quo, causing the patient to feel abnormal dizziness,” Conover explained.

The most common inner ear problem, caused by floating “rocks” in the ear being out of place, is Benign Paroxismal Positional Vertigo, or vertigo, Rudy added, noting that the terms dizziness and vertigo often are used interchangeably.

“If the room is spinning, that is vertigo. If you feel like you are walking on pillows, just don¹t feel right, that is dizziness,” Rudy said.  “The bottom line in either instance is why is it occurring, and what to do to return balance.”

The patient¹s ability to tell the history -­ when the dizziness began, when it mostly likely will occur and what they experience including nausea or vomiting -- is very important, Rudy said.

The duration of the vertigo gives clues as to the cause of the problem, said Ronald DeVore, M.D., of Upper Valley ENT (Ear, Nose and Throat).  He said vertigo also can be accompanied by other inner ear findings, including hearing loss, ringing, roaring-type tinnitus, or nausea and vomiting.

However, some vertigo can be an isolated symptom, he said.

Patients experiencing symptoms of vertigo or dizziness are encouraged to seek medical attention and have an extensive medical evaluation by their primary care physician.

”Once the brain and its circulation as well as the heart, blood vessels, and blood pressure are checked, many patients are then referred to an ENT physician,” Dr. DeVore said.  UVMC’s balance program provides initial consultations by the ENT physician.

The most common tool used to look at the inner ear is videonystagmography, VNG, which tracks eye movement through video recording, or ENG (electronystagmography) which is the recording of eye movements from electrical signals.

Rudy will conduct a battery of tests with selected tools, looking for the cause of dizziness.  Among information sought from tests is whether both ears are providing equal response to stimuli. If not, when the person moves, they will feel off-balance.

Dr. DeVore said treatment may consist of avoidance measures, medications, or physical therapy. It rarely may require surgery.

Conover said a repositioning of the “rocks” in the inner ear through the physical therapist guiding the head back and forth often is effective in one or two treatments.  Physical therapy also can be used to retrain the vestibular-ocular reflex using eye exercises.

“It is getting the eyes to stabilize on a target while the head moves really fast. That is what we are doing as we move around,” Conover said.  Exercises may include having patients hold a card with a letter on it, and shake their head back and forth while focusing on the letter.  Exercises over a few works, or months, may be needed.

“What is your normal tendency if you are dizzy?  It is, especially in the older population, to sit down, be still,” Rudy said.  “The brain has to compensate.  It has to be retrained otherwise you aren¹t going to move, and you aren¹t going to be well.”

“It is important for people, especially the elderly population, to know that dizziness is not a part of normal aging,” Conover said.  “Many are led to believe that."

“Our vestibular systems decline in their functions, just like our joints decline and vision declines with age, but dizziness in and of itself is not inherent in the aging process,” Conover explained.  “People really do need to go and find out if they have something that can be treated.”

For more information on the UVMC Vestibular and Balance program, call 440-4840 or 308-7000.  The Upper Valley ENT office of Dr. DeVore and Dr. Gordon Katz also can be contacted at 335-5806.