The key issues

Patients with balance disorders can experience a sense of imbalance, light-headedness and even vertigo. Vertigo is characterized by a sense of motion which is often spinning in nature. As the inner ear also has a balancing function, it is common to experience giddiness/vertigo in ear disorders. But the problem is there are many other non-ear related physiological and medical conditions that can result in such symptoms. Some of these can be serious such as a stroke or a brain tumour. Even in ear-related causes, part of the evaluation is to identify the affected side, which part of the ear is involved and the underlying causes(s). If necessary, we can tap on a range of diagnostic tools to assess the patients. Ultimately, an accurate diagnosis is key to successful treatment.

Evaluation

The diagnosis can be clinched in most patients from a careful a detailed history and careful medical examination. Because of the close relation between the inner ear’s hearing and balance functions, a hearing test is often part of the evaluation. Imaging studies or blood tests may be advised in some patients.

If necessary, we have a range of specific ear-related diagnostic tools to tap on:

  • Videonystagmography (VNG)

    VNG is a series of tests where eye movements are recorded by infrared camera while the patient lies in different positions. By assessing voluntary eye movements during these tests, the possible causes of dizziness or balance disorders may be identified.

  • Electrocochleography (ECoG)

    This is a test used to examine electrical potentials in the inner ear elicited by sound stimulation. It can be useful for diagnosing Meniere’s disease.

  • Vestibular Evoked Myogenic Potential (VEMP)

    This is a test used to evaluate one portion of the balance organ known as the saccules. Electrodes are placed on the neck muscles and sound is presented when the testing begins. Muscle activation is then measured.

Treatment

Treatment depends on the cause of vertigo, and may include:

Medications

Sometimes, medicine may be prescribed to alleviate symptoms of nausea or motion sickness caused by the vertigo. In Ménière's disease, diuretics may be given to reduce pressure from fluid accumulation.

Canalith Repositioning Manoeuvre

This is used to treat a type of vertigo that causes dizziness when you move your head. The procedure consists of a few simple head manoeuvres that move tiny particles in the inner ear canal (where they don’t belong and will cause dizziness) to another part of the ear where they won’t cause dizziness

Surgery

Should the vertigo be caused by a tumour or brain or neck injury, then surgery may be needed to treat the vertigo.

Vestibular Rehabilitation

This treatment is a form of physiotherapy that is performed with the goal of strengthening the vestibular system—a sensory system found in the inner ear that transmits signals to the brain regarding the body’s motion, head position, sense of balance and spatial orientation. Vestibular rehab will help improve balance and reduce problems related to dizziness

Acupuncture

Has role in selected patients with vertigo

A/Prof Dr Dr Low Wong Kein

Senior Consultant Ear, Nose & Throat Surgeon
Sub-specialty in Otology & Neuro-otology

MBBS (S’pore), PhD (S’pore)
FRCSG, FRCSEd, DLORCSEng, FAMS (ORL)
GradDip (Acupuncture)

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