Treatments: Balance
As unpleasant as dizziness is, there are treatments to improve the sensation, depending on the cause.
balance Physical therapy
Did you know that the balance system responds remarkably well to challenge? A physical therapy plan for balance includes safe methods to build one’s balance systems as well as focus on any physical or judgement weaknesses.
Canalolith repositioning therapy (CRT) for benign positional paroxysmal vertigo (BPPV)
For patients with BPPV, physical movements of the head to reposition the misplaced crystals (canaloliths) may be done. The most commonly used techniques are the Epley maneuver and the Semont maneuver. Please note that performing the Employ maneuver incorrectly, such as when the wrong semicircular canal is targeted, will make the situation worse.
• Animated video demonstrating the Epley maneuver for horizontal canal BPPV.
• Animated video demonstrating deep head hanging for superior canal BPPV.
treatment for meniere’s disease
While Meniere’s disease does not have a cure, the aims of treatment are:
to reduce the number, severity and duration of vertigo attacks;
to prevent progression of the disease, in particular the loss of hearing; and
to alleviate any chronic symptoms (e.g. tinnitus and a sense of ear fullness).
These may be accomplished with medical therapy. The main medical approaches consist of: 1) low salt diet and use of a diuretic (“water pill”), 2) use of betahistine, 3) use of lipoflavinoid, 4) injection of a steroid into the middle ear space though a tiny puncture hole of the ear drum and 5) destroying the inner ear with injection of a medicine (an aminoglycoside, like gentamycin).
Lessening the severity an active attack is often accomplished with a medication to treat nausea (such as meclizine) and a medication to treat the anxiety that accompanies dizziness (such as lorazepam).
Surgical treatments for Meniere’s disease is typically reserved for severe cases in which medical therapy has proven ineffective. The least destructive of the typical operative options involves decompressing the endolymphatic sac (with or without placement of a valve). For the most severe cases, cutting the balance nerve (vestibular neurectomy) or removing the inner ear (labyrinthectomy) may be considered. Hearing in that ear may be lost with vestibular neurectomy and is always lost with labyrinthectomy.
Eventually, after about 5-15 years of symptoms, Meniere’s disease usually “burns out” whereby hearing and balance function from the affected ear is lost, episodes of the world spinning generally stop and the person is left with mild loss of balance, moderately poor hearing in the affected ear, and ringing in their ear. The balance system may compensate based on the other ear, though this is aided by balance therapy and maintained by ongoing challenge to the vestibular system.
heart and vascular causes for dizziness
Of the many causes of dizziness, blood flow to the brain is a relatively common one. A sense of “vision going black,” almost losing consciousness (pre-syncope) or fully losing consciousness (syncope) are characteristics of a lack of blood flow to the brain. Low blood pressure even temporarily due to dehyration, standing up quickly or an irregular heart rhythm are some specific causes of dizziness from low brain blood flow. These conditions are managed by a cardiologist.
Neurologic causes for dizziness
Dizziness caused by brain conditions (such as stroke, multiple sclerosis, brain tumor) are managed by a neurologist, and appropriate referral can be made. Initiating physical therapy to help with imbalance and compensation is sometimes begun as the neurology referral is made.
Mal de debarquement syndrome
A continued sensation of movement or bobbing after exposure to motion, such as boating on unsteady water, may be prevented with use of a medication to desensitize the brain from stimulus of motion such as diphenhydramine (Benadryl), scopolomine (Transderm Scop), dimenhydrimate (Dramamine). Intentionally looking at the horizon during the motion event may also help prevent motion sickness. Once mal de debarquement has developed, and symptoms persist despite discontinued exposure to the inciting motion, activity such as walking, running, cycling, and so forth are thought to help restore a normal sense of balance.