Editing Balance disorder

{{Short description|Physiological disturbance of perception}}
{{Infobox medical condition (new)
| name            = Balance disorder
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| field           = {{plainlist|
* [[Neurology]]
* [[Otolaryngology]]}}
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A '''balance disorder''' is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness, or wooziness, or having a sensation of movement, spinning, or floating. [[Equilibrioception|Balance]] is the result of several body systems working together: the [[visual system]] (eyes), [[vestibular system]] (ears) and [[proprioception]] (the body's sense of where it is in space). Degeneration or loss of function in any of these systems can lead to balance deficits.<ref name="pmid19026966">{{cite journal | vauthors = Sturnieks DL, St George R, Lord SR | title = Balance disorders in the elderly | journal = Neurophysiol Clin | volume = 38 | issue = 6 | pages = 467–78 | date = December 2008 | pmid = 19026966 | doi = 10.1016/j.neucli.2008.09.001 | s2cid = 10370640 }}</ref>

==Signs and symptoms==
[[Cognitive]] dysfunction (disorientation) may occur with vestibular disorders.  Cognitive deficits are not just spatial in nature, but also include non-spatial functions such as object recognition memory.{{citation needed|date=September 2018}} Vestibular dysfunction has been shown to adversely affect processes of attention and increased demands of attention can worsen the postural sway associated with vestibular disorders. Recent [[MRI]] studies also show that humans with bilateral vestibular damage (damage to both [[inner ear]]s) undergo [[atrophy]] of the [[hippocampus]] which correlates with their degree of impairment on spatial memory tasks.<ref name="pmid15908735">{{cite journal | vauthors = Smith PF, Zheng Y, Horii A, Darlington CL | title = Does vestibular damage cause cognitive dysfunction in humans? | journal = J Vestib Res | volume = 15 | issue = 1 | pages = 1–9 | date = 2005 | doi = 10.3233/VES-2005-15101 | pmid = 15908735 }}</ref><ref name="pmid16141283">{{cite journal | vauthors = Brandt T, Schautzer F, Hamilton DA, Brüning R, Markowitsch HJ, Kalla R, Darlington C, Smith P, Strupp M | title = Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans | journal = Brain | volume = 128 | issue = Pt 11 | pages = 2732–41 | date = November 2005 | pmid = 16141283 | doi = 10.1093/brain/awh617 | doi-access = free}}</ref>

==Causes==
Problems with balance can occur when there is a disruption in any of the vestibular, visual, or proprioceptive systems. Abnormalities in balance function may indicate a wide range of pathologies from causes like inner ear disorders, low blood pressure, brain tumors, and brain injury including stroke.{{Citation needed|date=August 2019}}

===Related to the ear===
[[File:Balance Disorder Illustration A.png|thumb|Different sections of semicircular canals. [[Utricle (ear)|utricle]] and [[saccule]] are indicated by circles.|226x226px]]
Causes of dizziness related to the ear are often characterized by vertigo (spinning) and nausea. [[pathologic nystagmus|Nystagmus]] (flickering of the eye, related to the Vestibulo-ocular reflex [VOR]) is often seen in patients with an acute peripheral cause of dizziness.{{cn|date=December 2021}}
* [[Benign Paroxysmal Positional Vertigo|Benign paroxysmal positional vertigo]] (BPPV) – The most common cause of vertigo.  It is typically described as a brief, intense sensation of spinning that occurs when there are changes in the position of the head with respect to gravity. An individual may experience BPPV when rolling over to the left or right, upon getting out of bed in the morning, or when looking up for an object on a high shelf.<ref name="Bhattacharyya">{{cite journal | vauthors = Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schuring LT, Steiner RW, Whitney SL, Haidari J | title = Clinical practice guideline: benign paroxysmal positional vertigo | journal = Otolaryngol Head Neck Surg | volume = 139 | issue = 5 Suppl 4 | pages = S47–81 | date = November 2008 | pmid = 18973840 | doi = 10.1016/j.otohns.2008.08.022 | s2cid = 16175316 }}
*{{lay source |template=cite press release|url= http://eurekalert.org/pub_releases/2008-11/aaoo-edr102808.php |title = ENT doctors release national guideline on treatment for common cause of dizziness  |date = November 1, 2008|website = EurekAlert.org }}</ref> The cause of BPPV is the presence of normal but misplaced calcium crystals called [[otoconia]], which are normally found in the [[Utricle (ear)|utricle]] and [[saccule]] (the otolith organs) and are used to sense movement. If they fall from the utricle and become loose in the [[semicircular canals]], they can distort the sense of movement and cause a mismatch between actual head movement and the information sent to the brain by the inner ear, causing a spinning sensation.<ref name="Bhattacharyya" />

=== Migraine ===
[[Migraine]] headaches are a common [[neurological disease]]. Although typical migraines are characterized by moderate to severe throbbing [[headaches]], vestibular migraines may be accompanied by symptoms of vestibular disorders such as dizziness, disequilibrium, nausea, and [[vomiting]].<ref>{{Cite journal|title=Balance disorders and migraine|url=https://pubmed.ncbi.nlm.nih.gov/37263900/|journal=Musculoskeletal Science & Practice|date=August 2023|issn=2468-7812|pmid=37263900|pages=102783|volume=66|doi=10.1016/j.msksp.2023.102783|first1=Gabriela F.|last1=Carvalho|first2=Kerstin|last2=Luedtke|first3=Debora|last3=Bevilaqua-Grossi}}</ref>

===Presyncope===

[[Presyncope]] is a feeling of lightheadedness or simply feeling faint.  Syncope, by contrast, is actually fainting. A circulatory system deficiency, such as low blood pressure, can contribute to a feeling of dizziness when one suddenly stands up.<ref>{{cite web |title=Balance Disorders Symptoms, Causes, Treatment – What are the symptoms of a balance disorder? |url=http://www.medicinenet.com/vestibular_balance_disorders/page2.htm#what_causes_a_balance_disorder |access-date=2014-03-02 |publisher=MedicineNet}}</ref>

==Diagnosis==
The difficulty of making the right vestibular diagnosis is reflected in the fact that in some populations, more than one-third of the patients with a vestibular disease consult more than one physician – in some cases up to more than fifteen.<ref name="pmid26366566">{{cite journal | vauthors = van de Berg R, van Tilburg M, Kingma H | title = Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults | journal = ORL J Otorhinolaryngol Relat Spec | volume = 77 | issue = 4 | pages = 197–218 | date = 2015 | pmid = 26366566 | doi = 10.1159/000433549 | s2cid = 3667457 | doi-access = free }}</ref>

==Treatment==
There are various options for treating balance disorders. One option includes treatment for a disease or disorder that may be contributing to the balance problem, such as ear infection, [[cerebrovascular accident|stroke]], [[multiple sclerosis]], [[spinal cord injury]], [[Parkinson's]], neuromuscular conditions, [[acquired brain injury]], cerebellar dysfunctions and/or [[ataxia]], or some tumors, such as [[acoustic neuroma]]. Individual treatment will vary and will be based upon assessment results including symptoms, medical history, general health, and the results of medical tests. Additionally, tai chi may be a cost-effective method to prevent falls in the elderly.<ref name="pmid18505980">{{cite journal | vauthors = Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, Hain TC, Herdman S, Morrow MJ, Gronseth GS | title = Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 70 | issue = 22 | pages = 2067–74 | date = May 2008 | pmid = 18505980 | doi = 10.1212/01.wnl.0000313378.77444.ac | s2cid = 24158281 | doi-access = free }}</ref>

=== Vestibular rehabilitation ===
Many types of balance disorders will require balance training, prescribed by an occupational therapist or physiotherapist. [[Physiotherapist]]s often administer standardized outcome measures as part of their assessment in order to gain useful information and data about a patient's current status. Some standardized [[Balance (ability)|balance]] assessments or outcome measures include but are not limited to the Functional Reach Test, Clinical Test for Sensory Integration in Balance (CTSIB), [[Berg Balance Scale]] and/or [[Timed Up and Go test|Timed Up and Go]]<ref>{{cite book |title=Physical Rehabilitation |vauthors=O'Sullivan S, Schmitz T |date=August 2006 |isbn=978-0-8036-1247-1 |veditors=O'Sullivan S |volume=5 |chapter=8|publisher=F.A. Davis }}</ref>  The data and information collected can further help the physiotherapist develop an intervention program that is specific to the individual assessed. Intervention programs may include training activities that can be used to improve static and dynamic postural control, body alignment, weight distribution, [[ambulation]], fall prevention and sensory function.<ref>{{cite book | vauthors = O'Sullivan S, Schmitz T| title = Physical Rehabilitation | chapter = 13 | volume = 5 |veditors = O'Sullivan S| date = August 2006  | location = F. A. Davis Company | isbn = 978-0-8036-1247-1}}</ref>

===Bilateral vestibular loss===
Dysequilibrium arising from bilateral loss of vestibular function – such as can occur from ototoxic drugs such as [[gentamicin]] – can also be treated with balance retraining exercises (vestibular rehabilitation) although the improvement is not likely to be full recovery.<ref>{{cite journal | author=Horak FB | title=Postural compensation for vestibular loss and implications for rehabilitation | journal=Restor Neurol Neurosci | year=2010 | volume=28 | issue=1 | pages=57–68 |doi=10.3233/RNN-2010-0515 | pmid=20086283 | pmc=2965039}}</ref><ref>{{cite journal |vauthors=Alrwaily M, Whitney SL | title=Vestibular rehabilitation of older adults with dizziness | journal=Otolaryngologic Clinics of North America | year=2011 | volume=44 | issue=2 | pages=473–496 |doi=10.1016/j.otc.2011.01.015| pmid=21474018 }}</ref>

==Research==
Scientists at the National Institute on Deafness and Other Communication Disorders (NIDCD) are working to understand the various balance disorders and the complex interactions between the labyrinth, other balance-sensing organs, and the brain. NIDCD scientists are studying eye movement to understand the changes that occur in aging, disease, and injury, as well as collecting data about eye movement and posture to improve diagnosis and treatment of balance disorders. They are also studying the effectiveness of certain exercises as a treatment option.<ref>{{cite web|url = https://www.nidcd.nih.gov/health/balance|title = Balance Disorders|website = National Institute on Deafness and Other Communication Disorders}}</ref> Recently, a study published in JAMA Otolaryngology-Head & Neck Surgery found that balance problems are an indicator of mortality potentially due to altered metabolism of vestibular system.<ref name="pmid33704356">{{cite journal | vauthors = Cao C, Cade WT, Li S, McMillan J, Friedenreich C, Yang L | title = Association of Balance Function With All-Cause and Cause-Specific Mortality Among US Adults | journal = JAMA Otolaryngol Head Neck Surg | volume = 147 | issue = 5 | pages = 460–468 | date = May 2021 | pmid = 33704356 | pmc = 7953337 | doi = 10.1001/jamaoto.2021.0057 }}</ref>

== See also ==

* [[Hypokinesia]]
* <bdi>[[Tremor]]</bdi>
* <bdi>[[Huntington's disease]]</bdi>

==References==
{{Reflist}}

== External links ==
{{Spoken Wikipedia|Balance_disorder.ogg|date=2019-8-16}}
{{Medical resources
|   ICD10       = {{ICD10|H|81||h|80}}, {{ICD10|R|42||r|40}}
|   ICD9        = {{ICD9|780.4}}
}}

{{Hearing and balance}}

{{DEFAULTSORT:Balance Disorder}}
[[Category:Neurological disorders]]
[[Category:Diseases of the ear and mastoid process]]