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Science Capsule: Balance or Vestibular Disorders in Adults
Balance disorders can result from trauma, disease, or the effects of aging on all the balance-related systems. Vestibular dysfunction can lead to dizziness, vertigo, nausea, migraines, blurred vision, and various forms of postural instability. Episodes of vestibular dizziness or nausea may be relatively brief, but when present can be profoundly disturbing, including disorientation, falling, or even complete incapacitation from physical activity. About 15 percent of American adults (33 million) had a balance or dizziness problem during the past year.2 NIDCD research is supporting the development of more efficient vestibular testing for improved clinical diagnoses and effective pharmacological treatments for vertigo.
A common balance disorder affecting more than one-half million Americans is Ménière’s disease. It can develop at any age, but most often occurs in adults aged 40 to 60. Characteristic symptoms include a combination of vertigo, hearing loss, nausea, tinnitus, and a feeling of fullness in the ear. Ménière’s disease usually affects only one ear. At worst, intense vertigo causes a fall, called a “drop attack,” with possible injury. Because episodes can be repetitive (recurring several times a day, coming and receding over weeks or months) and intense, it can be very debilitating.
Dysfunctions of the vestibular system can occur independently or with a hearing loss, from causes like pharmacotoxicity or head trauma. NIDCD Intramural scientists, at the NIH Clinical Center, evaluate both hearing and vestibular function by testing individuals with and without balance disorders. The goal of the studies is to determine the best way to perform the testing and understand the variations among the test and different individuals. Examples of ongoing research include examining auditory or vestibular function in individuals with neurofibromatosis type 2, Usher syndrome, enlarged vestibular aqueducts, Niemann-Pick type C, xeroderma pigmentosum, and Moebius syndrome.
Balance disorders are associated, as mentioned, with falling, which is the leading cause of injury deaths among older adults. One in three Americans aged 65 and older falls each year 107-110, and falls can result in severe trauma and even loss of life. Each year, more than 4 million older U.S. adults go to emergency departments for fall-related injuries at a cost of $4 billion.111, 112 The NIDCD supports a longitudinal study that measures vestibular function in older adults. The NIDCD is also sponsoring the AVERT (Acute video-oculography for Vertigo in Emergency Rooms for rapid Triage) clinical trial to help diagnose vertigo, dizziness, and other balance problems. The team of researchers is using a diagnostic medical device (video-oculography or VOG) in the triage of patients who go to emergency room with complaints of vertigo and/or dizziness. The device measures abnormal eye movements to differentiate benign causes of the dizziness or imbalance from dangerous causes (like stroke). This study offers the potential for improving standard of care in the diagnosis and treatment of patients with vertigo or dizziness, leading to better outcomes at lower cost.
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