balance disturbances

8/12/2019 Balance Disturbances

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Jenny BashiruddinOtorhinolaryngology Head&Neck Surgery Department

Medical Faculty University of IndonesiaJakarta


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Vestibular system interacts with many otherparts of the nervous system

Symptoms may also be experienced asproblems with vision, muscles,thinking, andmemory.


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Maintaining balance is dependent on input

from a number of sources

Goebel JA. Otolaryngol Clin North Am 2000;33:483-93Shepard NT, Solomon D. Otolaryngol Clin North Am 2000;33:455-69


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Vertigo can be of central or peripheral origin

Baloh RW. Lancet 1998;352:1841

6. Mukherjee A et al. JAPI 2003;51:1095-101. Puri V, Jones E. J Ky Med Assoc2001;99:31621. Salvinelli F et al. Clin Ter 2003;154:3418. Strupp M, Arbusow V, Curr Opin Neurol 2001;14:1120.

Peripheral

Involving structures not

part of the central

nervous system, most

frequently the inner ear

Central

Involving structures in the

central nervous system

(e.g., cerebrum,

cerebellum, brainstem)


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Vascularisation


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Demographics of Dizziness / Vertigo

1/3 population by age of 65 years ( Roydhouse 1974 )

48% women and 37% men by 80 years ( Pemberton 1956 )

5/1000 consult GP for vertigo ( RCMOP /OPCS 1986 )

10/1000 consult GP for dizziness ( RCMOP /OPCS 1986 )

1 in 4 adults in community report dizziness ( Yardley et al1998 )


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Symptoms The most frequently reported symptoms of vestibular

disorders are dizziness, unsteadiness or imbalancewhen walking, vertigo, and nausea.

These symptoms may be quite mild, lasting minutes,or quite severe, resulting in total disability.


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Symptoms In addition, may suffer headache and muscular aches

in the neck and back,

increased sensitivity to noise and bright lights. fatigue and loss of stamina and an inability to

concentrate.

may be accompanied by irritability, loss of self-esteem,

and/or depression.


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Symptoms Balance disorders increase in frequency in the older

age groups and increased by age 75 years

In general, the more violent and spinning thesensation of vertigo, the more likely the lesion ifperipheral.

Central lesions tend to cause less intense vertigo and

more vague symptoms.


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Some studiesPyykko et allage influence balance problem,Starude et allbalance disturbance in elderly80% Balance problem was periferal vestibulerdisturbance

Nevitt et al. (1989), falls in elderly 60-70% werefalls in the next 12 months.Balance problem will increase frequency of falls inelderly

Balance problem in elderly was based onchanges in vestibular, visual, somatosensoris organ


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Changes in elderlyNeurologis changes- nerve conduction system- Cognitive function

- disturbances Brain cell- Vibration sensation loss

Eyes degeneration

- thickening of Lens

decrease accommodation flexibility- Changes in retinadecrease ability to catch the light


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Changes in elderlyMusculoskeletal degeneration

- less muscles mass

- Cardiovascular less ability for nutritionsupply

- Other Degeneration process


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Vertebrobasilar arterial insufficiency, Cervicalarthritis, Carotid artery stenosis can cause vertigo,

usually with associated nausea, vomiting. It iscommonly diagnosed in dizzy patients who areolder than 50.


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High doses or long-term use of certain antibiotics

can also cause permanent damage to the inner ear.

Other drugs, such as aspirin, caffeine, alcohol,nicotine, sedatives, and tranquilizers, as well as

many illegal drugs, can cause temporary dizzinessbut do not result in permanent damage to thevestibular system. [Ototoxicity].
http://www.vestibular.org/ototox.htmlhttp://www.vestibular.org/ototox.html


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Diagnosis & ExaminationAnamnesis/History ofthe problem- Onset,Intensity,Duration- Changes potitions

- Episodic/continues- Other disease- Ototoxic drug- Trauma

Cerebelum exam- Past pointing test- Finger noseTest


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VRT


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balance disturbances

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