Medical Edge Newspaper Column

Finding Source Of Balance Problem Key To Treating It

Feb. 27, 2006
DEAR MAYO CLINIC:
I've had balance problems for more than three years. My ENT doctor has told me that I have fluid in the inner ear. I have had some therapy, but nothing helps. Is there any new treatment on the horizon?

ANSWER:
Balance problems are a common complaint, particularly as people age. Seeking treatment is important because injuries from falls are a major source of disability in the elderly.

Imbalance can have many different causes. Often, the biggest challenge is to find the cause. If your treatment hasn't worked, perhaps not all contributing factors have been identified.

Imbalance may occur any time the neuromuscular system doesn't provide proper strength or coordination, or if the sensory system (vision, sensation in the feet, inner ear function) doesn't send reliable information to the brain.

Central nervous system disorders can lead to loss of postural control, strength or coordination. Peripheral nervous system disorders may make limbs weak or numb and impair balance.

Other possibilities include:

• Dysfunction of the inner ear vestibular labyrinth (balance portion of the inner ear) that may cause vertigo or imbalance.

• Orthopedic or visual problems may compound the difficulty.

• Low blood pressure or cardiovascular problems may lead to light-headedness, dizziness or fainting.

Positional vertigo (brief dizziness or vertigo when looking up or rolling over in bed) is the most common form of vertigo. Once properly diagnosed, it can generally be treated with simple maneuvers. Other causes of vertigo may require different treatment.

Generally, fluid in the middle ear will not lead to vertigo unless a chronic infection involves the inner ear's vestibular labyrinth. The normal fluid in the labyrinth helps you sense head movements and maintain balance, although sometimes the fluid dynamics can become altered.

I'd recommend that you see your physician to review these potential causes. Work with a neurologist or an ear, nose and throat (ENT) physician who specializes in dizziness for further evaluation if the problem's cause is still unclear. Once a cause is determined, a treatment plan can be developed. New treatments continue to be developed to treat vertigo and imbalance.

-- Scott Eggers, M.D., Neurology, Mayo Clinic, Rochester, Minn.