Inner Ear Balance Disorders Come with Age; Major
Cause of Falls by Senior Citizens
Vestibular disorders are most common cause of
dizziness in older people, responsible for 50% of dizziness in elderly.
May 26, 2009 Vestibular disorders (inner ear
balance disorders) are the most common cause of dizziness in senior
citizens a majority of the elderly over age 70 report dizziness and
imbalance - and a majority of the accidental deaths from falls by older
people are related to balance problems.
An estimated 35 percent of U.S. adults age 40 and
older have vestibular dysfunction and it only gets worse with aging,
according to a report in the May 25 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.
One-third of people age 65 through 75 participating
in a survey reported dizziness and imbalance degraded the quality of
their lives, according to the Vestibular Disorders Association.
The vestibular system helps control an individuals
balance, according to background information in the article. The two
vestibular organs, within the temporal bone at the side and base of the
skull, provide input to the brain about head motion and orientation
relative to gravity.
"Vestibular dysfunction is typically characterized
by vertigo (i.e., an illusory sense of motion) and imbalance owing to
disturbances in gaze and postural stability," the authors write.
"In some cases, vestibular dysfunction can
culminate catastrophically in a fall, which is associated with serious
injury and restricted mobility and ranks among the leading causes of
death among older individuals."
Despite these concerns, little has previously been
known about the prevalence of vestibular dysfunction in the United
States, in part because of the difficulty of diagnosis.
Yuri Agrawal, M.D., and colleagues at The Johns
Hopkins University School of Medicine, Baltimore, analyzed data from a
nationally representative sample of 5,086 adults who participated in the
2001-2004 National Health and Nutrition Examination Surveys.
Participants completed a balance questionnaire,
which determined history of dizziness and falls, and underwent in-person
balance testing that involved standing on different surfaces under
varying conditions (for instance, with their eyes closed).
As determined by these tests, the overall
prevalence of vestibular dysfunction in the U.S. population aged 40 and
older from 2001 through 2004 was 35.4 percent.
"Odds of vestibular dysfunction increased
significantly with age, were 40.3 percent lower in individuals with more
than a high school education and were 70 percent higher among people
with diabetes mellitus," the authors write.
Individuals with vestibular dysfunction were more
likely to report having dizziness and a history of falls. The 26.8
percent of participants who had symptoms of vestibular dysfunction,
including dizziness, had an eight-fold increase in the odds of falling.
Individuals who were asymptomatic also had
significantly increased odds of falling.
In addition, participants with vestibular
dysfunction had an increased risk of hearing loss, which likely reflects
the similar anatomic locations of the vestibular and hearing organs as
well as their common blood supply.
"These findings suggest the importance of
diagnosing and treating vestibular deficits to reduce the burden of
fall-related injuries and deaths," the authors write.
"Given the high prevalence of this impairment,
notably among the elderly, and the extraordinary costs associated with
falls (exceeding $20 billion annually), screening for vestibular
dysfunction in assisted living or nursing home facilities, for example,
could be a life-saving and cost-effective practice. Screening may be
particularly effective in groups at heightened risk of vestibular
dysfunction, specifically non-whites, individuals with less than a high
school education, people with diabetes and the hearing impaired."
Aging, Balance, and Dizziness
By Vestibular Disorders Association
Balance: One of the leading health concerns for
people over 60 is falling. Balance in walking and standing is dependent
on many factors. The elderly have a higher risk of contracting many
different kinds of diseases that can interfere with balance, including
cataracts, glaucoma, diabetic retinopathy, and macular degeneration,
which all affect vision; peripheral neuropathy, which affects position
sense in the feet and legs; and vestibular-system degeneration.
Balance is also dependent on good muscle strength
and joint mobility. A sedentary lifestyle and arthritis or other
diseases of bones and muscles can compromise strength and mobility. Yet
even healthy people over 65 appear to have more trouble than younger
people in maintaining their balance on soft or uneven surfaces when
visual cues are not available (e.g., in the dark).
Dizziness in the elderly can be a result of
problems with the vestibular, central (brain-related), and vision
systems, as well as from neuropathy, psychological causes, and unknown
causes. Vestibular disorders, however, are thought to be the most common
cause of dizziness in older people, responsible for approximately 50% of
the reported dizziness in the elderly.
Until recently, relatively little was known about
the consequences of aging for the vestibular system. Anatomical studies
have shown that the number of nerve cells in the vestibular system grows
smaller with age, beginning at about age 55. The loss becomes more
severe as age progresses.
Of all vestibular disorders, benign paroxysmal
positional vertigo (BPPV) is one of the most common. See the description
of
BPPV
and treatment for it through vestibular rehabilitation therapy
(balance-retraining exercises and maneuvers).
The ability to move about freely is an important
factor in the quality of life of both younger and older people. A
healthy vestibular system is vitally important to freedom of movement.
Benign Paroxysmal Positioned Vertigo
is Most Common Problem
Most experts regard
Benign Paroxysmal Positional Vertigo (BPPV) as the most commonly
diagnosed vestibular disorder. It accounts for at least 20 percent of
diagnoses made by doctors specializing in dizziness and vestibular
disorders. It is the most frequent cause of vertigo in the elderly. The
number of people affected by this disorder each year has been estimated
between 10 per 100,000 and 64 per 100,000 people, and some experts feel
even more may be affected.
About Benign paroxysmal positional
vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is a
disorder that causes vertigo, dizziness, and other symptoms due to
debris that has collected within a part of the inner ear. This debris,
called otoconia, is
made up of small crystals of calcium carbonate (sometimes referred to
colloquially as ear rocks). With head movement, the displaced otoconia
shift, sending false signals to the brain.
Symptoms of BPPV are almost always precipitated by
a change in head position. Getting out of bed and rolling over in bed
are two common "problem" motions. Some people feel dizzy and unsteady
when they tip their heads back to look up. An intermittent pattern of
these symptoms is usual.
About 20% of all dizziness is due to BPPV. The most
common cause of BPPV in people under age 50 is head injury. About 50% of
dizziness in older people is due to BPPV. In half of all cases, BPPV is
idiopathic, which means that it occurs for no known reason. BPPV is also
associated with
migraine.
Diagnostic tests for BPPV include tests that look for the
characteristic nystagmus (jumping of the eyes), such as the Dix-Hallpike
test and electronystagmography (ENG).
Particle-repositioning maneuvers, including the Epley maneuver and
the Semont-liberatory maneuver, are very effective in treating BPPV and
can be performed in the doctor's office in about 15 minutes. The goal of
these maneuvers is to move the detached otoconia out of one of the
semicircular canals. Treatment may also include individualized
vestibular physical therapy exercises designed to help retrain the
brain. The Brandt-Daroff habituation exercises are sometimes
recommended and can be done at home. Canal-plugging
surgery may be another option.
Inside your ear is a tiny organ called the
vestibular labyrinth. It includes loop-shaped structures (semicircular
canals) that contain fluid and fine, hair-like sensors that monitor the
rotation of your head. Other structures (otolith organs) in your ear
monitor movements of your head and your head's position. These otolith
organs contain crystals that make you sensitive to movement. For a
variety of reasons, these crystals can become dislodged. When they
become dislodged, they can move into one of the semicircular canals
especially while you're lying down. This causes the semicircular canal
to become sensitive to head position changes it would normally not
respond to. As a result, you feel dizzy.
Benign paroxysmal positional vertigo occurs most
often in people age 60 and older. It can also occur after a minor to
severe blow to your head. Less common causes of BPPV include disorders
that damage your inner ear or, rarely, damage that occurs during ear
surgery or during prolonged positioning on your back (supine).
Doctors can sometimes determine the cause of BPPV.
It may require a consultation with an ear, nose and throat (ENT)
specialist or a doctor who specializes in the brain and nervous system
(neurologist). However, it is almost as common that no specific cause
for BPPV can be determined.
Risk factors
Aside from aging, there are no definite factors
that may increase your risk of benign paroxysmal positional vertigo.
However, a prior head injury or any other disorder of the balance organs
of your ear may make you more susceptible to BPPV.
May 26, 2009 Vestibular disorders (inner ear
balance disorders) are the most common cause of dizziness in senior
citizens a majority of the elderly over age 70 report dizziness and
imbalance - and a majority of the accidental deaths from falls by older
people are related to balance problems.
