SayWhatClub March 2007 Newsletter

PEARL: It is my understanding, and please correct me if I'm wrong, that there are several diagnoses for balance problems that are related to the inner ear. They are: acoustic neuroma, vestibular neuritis, Benign Paroxysmal Positional Vertigo (BPPV), Meniere's Disease, bilateral vestibular problems and perilymph fistula.

What are the differences in the above and how common are they?

Dr. Hain: The most common of cause of inner ear dizziness is BPPV. It causes about 50% of all inner ear dizziness. It differs from the others in that a brief dizziness is only triggered by changing head position. Hearing is generally not affected in BPPV.

Next most common is vestibular neuritis. Again, hearing is unaffected, by definition. This condition is associated with constant dizziness for several weeks.

Next is Meniere's Disease. It is a chronic condition typified by bouts of dizziness, hearing loss, tinnitus, and ear fullness.

Finally, there are some rather rare conditions. Bilateral vestibular problems are usually caused by exposure to toxic medications, such as gentamicin. Usually there is no hearing problem.

Acoustic neuromas are rare tumors that mainly cause hearing loss. They grow slowly over years, and eventually the person with them goes deaf on one side. Perilymph fistulae are breaks between the middle ear and inner ear. They are mainly associated with head injuries or pressure injuries, such as in scuba diving.

PEARL: Can any of the above-mentioned be inter-related?

Dr. Hain: There is a strong association between vestibular neuritis and BPPV. Often people start with vestibular neuritis, which later turns into BPPV.

PEARL: Is there a general age group that is more affected than another by balance disorders or can it hit anyone at anytime?

Dr. Hain: In the general population, balance gets slowly worse with age. At the age of 80, balance usually starts to go downhill at a faster rate. If one lives long enough, balance impairment always restricts one's activities.

PEARL: How does one get properly diagnosed and what can they expect concerning help?

Dr. Hain: Some of these illnesses are rather simple -- BPPV in particular is easily diagnosed and is also effectively treated. Vestibular neuritis is also easily diagnosed, and can be treated by most doctors. Meniere's Disease is the next most important one. It is usually diagnosed from hearing tests done by ear doctors. There have been some important recent advances in the treatment of Meniere's Disease -- low-dose gentamicin is a significant new treatment. The remaining disorders are rare enough that generally only fairly narrowly specialized doctors diagnose them -- these specialists nearly always have "otologist" in their name.

PEARL: Clearly, every case is an individual case and each person is not remedied in the same fashion. In our membership, I have heard people share their stories and discuss the physical symptoms and distress caused by Meniere's. Can you recommend any alternative help in addition to what the individuals may already be doing, such as yoga, biofeedback, etc? Do you know whether these alternative methods have been successful for the use of balance disorders?

Dr. Hain: Meniere's Disease is often treated with alternative methods -- although many of them are probably placebos, that mainly help by making the patient feel as if they have some control over this awful disease. Vitamins are commonly used (such as Lipoflavenoids). Medications that are not FDA approved (such as betahistine) are used worldwide. There is also a very long history of ineffective treatments -- medications, devices and surgeries -- being used for Meniere's, for much the same reason. Torok wrote the classic article on this -- "Old and New in Meniere's."

While I am generally sympathetic to patients trying everything, I counsel people to avoid most of the ones that involve surgery or that are costly.

Yoga and Tai Chi are helpful for balance. In a study that I did about a decade ago, I found that Tai Chi improved balance by about 10%. Acupuncture may be worth a try too.

The big news with Meniere's Disease, though, is low-dose gentamicin treatment. This is not an alternative treatment, but it is a highly effective variant of an old treatment. It is a very effective treatment for the vertigo of Meniere's Disease.

Timothy C. Hain, M.D. serves as Vice President of the American Hearing Research Foundation, and serves on the Foundation's Research Committee as well. Dr. Hain also serves on Medical Advisory Board of the Vestibular Diseases Association, and on the Editorial Boards of the Journal of Vestibular Research and Contemporary Medicine International.

Dr. Hain is currently Associate Professor of Neurology and Laryngology at Northwestern University. His clinical practice focuses on evaluation and treatment of conditions that produce dizziness. He has also received several National Institutes of Health grants to investigate causes and treatments of dizziness and imbalance.

He has published many articles in scientific journals, as well as chapters of textbooks, regarding the diagnosis and treatment of dizziness.