Feeling Dizzy? Get Treated to Get Back in the Game

Story by Ken Cornwell

Defense Health Agency

Experiencing short- or long-term problems with dizziness and balance? You’re not alone.

Issues with dizziness and balance are some of the most common reasons patients visit their primary care provider, according to clinical practice guidelines from the Department of Defense and Department of Veterans Affairs. Often, the cause of balance problems stems from an issue happening within the inner ear.

“The inner ear is comprised of the auditory system and vestibular system,” said Robin Pinto, an audiologist with the Walter Reed National Military Medical Center. “The vestibular system controls balance.”

“You have two structures, the organs of hearing and organs of balance, connected and housed inside a bony labyrinth,” she explained. “They share the same inner ear fluids comprised of sodium and potassium, they receive their blood supply from the same artery, and send sensory information to the brain through the same cranial nerve.”

“Any disruption to those fluids and the vascular supply, or an interruption to the signal the organs are sending to the brain, could cause a chain reaction of problems.”

These signals from the balance organ are sent to many places throughout the body.

“Information goes to our spinal reflex. It goes to our eyes or our vision. It goes to our spatial orientation system. This information even plays a role in blood pressure regulation,” said Pinto. “Our brain uses this to know when you’re lying flat or standing up to help regulate blood pressure.”

According to the National Institute on Deafness and Other Communications Disorders, interruptions to information delivery can be caused by infection, virus, head trauma, or stroke. Other causes include a build-up of fluid in the inner ear, called Ménière’s disease, migraine headaches, and certain antibiotics and medications. These interruptions can result in symptoms such as:

• Vertigo and dizziness
• Imbalance and spatial disorientation
• Blurred vision
• Hearing loss
• Nausea and disorientation

“These symptoms can be disheartening to the patient,” said Holly Burrows, chief of audiology at WRNMMC. “They may not be feeling well or may even become incapacitated.”

“This obviously could have an impact maybe on a person’s career field if they need those functions to perform,” said Pinto.

“In addition, these disorders could just be transient and brief, such as a migraine causing a hearing or balance disruption, but some could be more long term,” she noted.

Burrows said, the duration of the disorder is sometimes dependent on its cause, and if it’s affecting both hearing and balance.

“But it also can be determined by how those problems are evaluated and managed,” she said. “Initiating management of these disorders in a timely fashion might mitigate some of those long-term impacts.”

Balance Issues in the Military

While balance disorders can affect almost anyone, service members are at greater risk for certain types of inner ear damage because of the unique circumstances they may face, noted U.S. Army Lt. Col. Kara Cave, chief of the Fort Liberty Hearing Program and an audiology consultant for the Office of the U.S. Army Surgeon General. “Notably, blast overpressure can impinge on immediate functioning of both hearing and balance systems.”

Balance issues can pose a serious threat to the mission.

“A balance problem could be more immediately detrimental than a hearing one,” said Cave. “If you cannot maintain balance, especially in a darker environment, you become an immediate threat to the mission.”

Testing, Diagnosis, and Treatment

“When you have sudden, acute changes, we want you to go to the ER,” cautioned Pinto. “However, if your symptoms are less severe, you’re likely to start with primary care, and we rely on our primary care assessments to drive referrals.”

Pinto recommends getting patients to the audiologist quickly as they are best equipped to identify vestibular disorders occurring in the ear.

“Providers often refer patients to an ear, nose, and throat doctor, but we recommend starting with an audiologist,” she said. “The ENT likely needs audiology results before they can make a diagnosis. The assessments we provide help get to the diagnosis and treatment faster.”

Audiologists use a variety of methods to identify the problem, Pinto continued.

“We start by listening to the patient’s story … what are their symptoms? What are their triggers?”

They continue evaluation with several different tests.

“There are tests that can identify, for example, if you’re having positional dizziness. We’ll test different positions and see what triggers your dizziness,” she said. “But the most common test, called videostagmography, involves tracking the pattern of your eye movements. This can tell us if your vestibular system has an appropriate ocular response.”

Ultimately, treating balance disorders quickly leads to better outcomes for patients.

“Dizziness can have a simple solution, but it can also be very complex,” said Burrows. “Furthermore, whether it’s an acute problem or a chronic problem, it can be scary for the patient … the sooner we can get them to the right people for evaluation, the better the possibility we can help manage the issue and put the patient at ease.”

To learn more about the assessment and treatment of vestibular disorders, the Defense Health Agency Hearing Center of Excellence offers additional resources including clinical practice guidelines, vestibular home exercise reference videos, Military Vestibular Assessment and Rehabilitation training videos, and diagnostic and coding guidance.