Two of the three “standardized field sobriety tests” - the walk and turn as well as the one leg stand - are premised on the assumption that people who are not under the influence of alcohol can perform the tests satisfactorily. However, many people do not have particularly good balance, and then there are those who suffer from a balance disorder. When balance is impaired, an individual has difficulty maintaining orientation. For example, an individual may experience the “room spinning” and may not be able to walk without staggering, or may not even be able to arise. Some of the symptoms a person with a balance disorder may experience are:
A sensation of dizziness or vertigo (spinning).
Falling or a feeling of falling.
Lightheadedness or feeling woozy.
Some individuals may also experience nausea and vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, anxiety, or panic. Some reactions to the symptoms are fatigue, depression, and decreased concentration. The symptoms may appear and disappear over short time periods or may last for a longer period of time.
Infections (viral or bacterial), head injury, disorders of blood circulation affecting the inner ear or brain, certain medications, and aging may change our balance system and result in a balance problem. Individuals who have illnesses, brain disorders, or injuries of the visual or skeletal systems, such as eye muscle imbalance and arthritis, may also experience balance difficulties. A conflict of signals to the brain about the sensation of movement can cause motion sickness (for instance, when an individual tries to read while riding in a car). Some symptoms of motion sickness are dizziness, sweating, nausea, vomiting, and generalized discomfort. Balance disorders can be due to problems in any of four areas:
Peripheral vestibular disorder, a disturbance in the labyrinth.
Central vestibular disorder, a problem in the brain or its connecting nerves.
Systemic disorder, a problem of the body other than the head and brain.
Vascular disorder, or blood flow problems.
Some of the more common balance disorders are:
Benign Paroxysmal Positional Vertigo (BPPV)–a brief, intense sensation of vertigo that occurs because of a specific positional change of the head. An individual may experience BPPV when rolling over to the left or right upon getting out of bed in the morning, or when looking up for an object on a high shelf. The cause of BPPV is not known, although it may be caused by an inner ear infection, head injury, or aging.
Labyrinthitis–an infection or inflammation of the inner ear causing dizziness and loss of balance.
Ménière’s disease–an inner ear fluid balance disorder that causes episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears), and the sensation of fullness in the ear. The cause of Ménière’s disease is unknown.
Vestibular neuronitis–an infection of the vestibular nerve, generally viral.
Perilymph fistula–a leakage of inner ear fluid to the middle ear. It can occur after head injury, physical exertion or, rarely, without a known cause.
Diagnosis of a balance disorder is complicated because there are many kinds of balance disorders and because other medical conditions–including ear infections, blood pressure changes, and some vision problems–and some medications may contribute to a balance disorder. A person experiencing dizziness should see a physician for an evaluation.
The primary physician may request the opinion of an otolaryngologist to help evaluate a balance problem. An otolaryngologist is a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck, with expertise in balance disorders. He or she will usually obtain a detailed medical history and perform a physical examination to start to sort out possible causes of the balance disorder. The physician may require tests to assess the cause and extent of the disruption of balance. The kinds of tests needed will vary based on the patient’s symptoms and health status. Because there are so many variables, not all patients will require every test.
Some examples of diagnostic tests the otolaryngologist may request are a hearing examination, blood tests, an electronystagmogram (ENG–a test of the vestibular system), or imaging studies of the head and brain.
The caloric test may be performed as part of the ENG. In this test, each ear is flushed with warm and then cool water, usually one ear at a time; the amount of nystagmus resulting is measured. Weak nystagmus or the absence of nystagmus may indicate an inner ear disorder.
Another test of the vestibular system, posturography, requires the individual to stand on a special platform capable of movement within a controlled visual environment; body sway is recorded in response to movement of the platform and/or the visual environment.